Feasibility of combined operation and perioperative intensity-modulated brachytherapy of advanced/recurrent malignancies involving the skull base.
OBJECTIVE
To assess the technical feasibility and toxicity of combined operation and perioperative intensity-modulated fractionated interstitial brachytherapy (IMBT) in advanced-stage malignancies involving the skull base with the goal of preserving the patients' senses of sight.


METHODS
This series consisted of 18 consecutive cases: ten patients with paranasal sinus carcinomas, five with sarcomas, two with primitive neuroectodermal tumors (PNETs), and one with parotid gland carcinoma. After, in most cases, subtotal surgical resection (R1-R2: carried out so that the patients' senses of sight were preserved), two to twelve (mean five) afterloading plastic tubes were placed into the tumor bed. IMBT was performed with an iridium-192 stepping source in pulsed-dose-rate/high-dose-rate (PDR/HDR) afterloading technique. The total IMBT dose, ranging from 10 to 30 Gy, was administered in a fractionated manner (3-5 Gy/day, 5 days/week).


RESULTS
Perioperative fractionated IMBT was performed in 15 out of 18 patients and was well tolerated. Complications that partially prevented or delayed IMBT in some cases included cerebrospinal fluid leakage (twice), meningitis (twice), frontal brain syndrome (twice), afterloading tube displacement (twice), seizure (once), and general morbidity (once). No surgery- or radiation-induced injuries to the cranial nerves or eyes occurred. Median survival times were 33 months after diagnosis and 16 months after combined operation and IMBT.


CONCLUSIONS
Perioperative fractionated IMBT after extensive but vision-preserving tumor resection seems to be a safe and well-tolerated treatment of advanced/recurrent malignancies involving the skull base. These preliminary data suggest that combined operation and perioperative fractionated IMBT is a palliative therapeutic option in the management of fatal malignancies involving the base of the skull, a strategy which leaves the patients' visual acuity intact.
Strege
Rainer J
RJ
Department of Neurosurgery, University Hospital Schleswig-Holstein Campus Kiel, Germany.
Kovács
György
G
Maune
Steffen
S
Holland
Detlef
D
Niehoff
Peter
P
Eichmann
Thomas
T
Mehdorn
H Maximilian
HM
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005131:Eye Injuries / Q000209:etiology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D010166:Palliative Care; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D012720:Severity of Illness Index; D012888:Skull Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome