title: Stereotactic 125iodine brachytherapy for the treatment of singular brain metastases: closing a gap?
abstract: BACKGROUND
  Brain metastases represent the most common intracranial tumors and are associated with very poor prognosis.
  
  
  OBJECTIVE
  To investigate the feasibility, survival, and cerebral disease control of patients with singular brain metastases treated with stereotactic 125iodine brachytherapy (SBT), to identify prognostic factors, and to compare results with other local treatment methods.
  
  
  METHODS
  Complications, survival (overall and separated by recursive partitioning analysis [RPA] classes), and local and distant disease control were evaluated retrospectively in 90 patients. Prognostic factors were identified by forming subgroups of patients based on age, Karnofsky Performance Status, status of extracranial disease, interval since initial diagnosis, absence/presence of prior whole-brain radiation therapy, localization, morphology, and tumor volume.
  
  
  RESULTS
  There was no treatment-related mortality, and morbidity was transient and low (3.3%). Median survival was 8.5 months overall and 18.1 months for RPA class 1 patients. After 1 year, the actuarial incidence of local and distant cerebral relapse was 5.4% and 46.4%, respectively. Karnofsky Performance Status ≥ 70 (P < .002), stable systemic disease (P < .02), RPA class 1 (P < .02), and a prolonged (> 12 month) interval between initial diagnosis and SBT (P < .05) significantly improved survival. No significant influence of previous whole-brain radiation therapy on survival or cerebral disease relapse was found.
  
  
  CONCLUSIONS
  SBT represents a safe, minimally invasive, and, compared with SRS and microsurgery, a similarly effective local treatment option in terms of survival and cerebral disease control. It allows histological (re-)evaluation and treatment within 1 stereotactic operation. Because it is less restricted by tumor localization or size, it greatly advances local treatment options, and on the basis of its favorable biological irradiation effect, SBT does not limit additional irradiation treatment in the event of disease relapse.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, Albertus Magnus University of Cologne, Otto v. Guericke University, Magdeburg, Germany. maximilian.ruge@uk-koeln.de
authors.forename: Maximilian I
authors.initials: MI
authors.lastname: Ruge
authors.forename: Bogdana
authors.initials: B
authors.lastname: Suchorska
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.forename: Matthias
authors.initials: M
authors.lastname: Runge
authors.forename: Harald
authors.initials: H
authors.lastname: Treuer
authors.forename: Jurgen
authors.initials: J
authors.lastname: Voges
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods* / Q000401:mortality; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes