title: Interstitial brachytherapy using stereotactic implanted (125)iodine seeds for recurrent medulloblastoma.
abstract: OBJECTIVE
  To evaluate the efficacy of interstitial brachytherapy using (125)iodine ((125)I) seeds for the treatment of recurrent multimodal treated medulloblastoma.
  
  
  METHODS
  Between September 1989 and August 2009, 12 patients (female:male=3:9, median age 19 years, range 7-55 years) with 23 recurrent medulloblastomas underwent interstitial brachytherapy using (125)I seeds. Before brachytherapy, all patients underwent microsurgical resection; six patients underwent a combined adjuvant treatment consisting of craniospinal irradiation and chemotherapy; three received craniospinal irradiation alone and two received chemotherapy alone. One patient was treated by surgery alone. The median tumour volume was 4.9ml (range 0.4-44.2ml), the median tumour surface dose 50Gy (range 32-50Gy) and the median implantation time 42 days (range 42-90 days). A median follow-up of 26 months was available (range 5-116 months).
  
  
  RESULTS
  After brachytherapy, nine of 23 tumours (39%) presented a complete remission, nine (39%) a partial remission and five (22%) stable disease on magnetic resonance images. The neurological status improved in six patients and remained unchanged in four. Two patients deteriorated: one developed spinal metastasis and another a treatment-related adverse radiation effect. Ten patients died due to disseminated disease despite local tumour control. The median survival after treatment was 15 months (range 5-68 months).
  
  
  CONCLUSIONS
  Our results show a good response of recurrent medulloblastoma after interstitial brachytherapy. High rates of tumour remission were yielded with low rates of treatment-related morbidity. Thus, (125)I seed brachytherapy should be considered as a treatment option for recurrent medulloblastoma.
authors: Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Germany.
authors: F
authors: F
authors: El Majdoub
authors: T
authors: T
authors: Simon
authors: M
authors: M
authors: Hoevels
authors: F
authors: F
authors: Berthold
authors: V
authors: V
authors: Sturm
authors: M
authors: M
authors: Maarouf
mesh_terms: D000293:Adolescent; D000328:Adult; D001918:Brachytherapy; D002528:Cerebellar Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008527:Medulloblastoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D016879:Salvage Therapy; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes