Management of newly diagnosed single brain metastasis with surgical resection and permanent I-125 seeds without upfront whole brain radiotherapy.
In this retrospective study, we evaluate the efficacy of surgical resection and I-125 seeds, without upfront whole brain radiotherapy (WBRT), for newly diagnosed single brain metastasis. About 40 women and 32 men underwent gross total resection and placement of permanent low-activity I-125 seeds at our institution (1997-2007). Primary systemic cancer sites varied. At follow-up (median 16 months), local control rate was 93%. Distant brain failures occurred in 23 (32%) patients: 5 patients within 3 months and 18 patients >3 months; brain failure underwent further treatment (i.e., radiosurgery in 13, WBRT in 5, surgical resection with I-125 seeds in 2). Four patients developed radiation necrosis. All 72 patients had stable or improved Karnofsky Performance Score at 1 month after surgery. Median actuarial survival rate was 14 months; 2-year survival rate was 27%. Permanent I-125 brachytherapy at initial operation without WBRT provided excellent local control. 67 patients (93%) never required WBRT, thus avoiding potential long-term radiation-induced neurotoxicity.
Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA.
Michael J
MJ
Petr
Christopher M
CM
McPherson
John C
JC
Breneman
Ronald E
RE
Warnick
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
D007457:Iodine Radioisotopes