title: Stereotactic brachytherapy with iodine-125 seeds for the treatment of inoperable low-grade gliomas in children: long-term outcome.
abstract: OBJECTIVE
  Resection is generally considered the gold standard for treatment of low-grade (WHO grades I and II) gliomas (LGGs) in childhood. However, approximately 30% to 50% of these tumors are inoperable because of their localization in highly eloquent brain areas. A few reports have suggested stereotactic brachytherapy (SBT) with implantation of iodine-125 ((125)I) seeds as a safe and effective local treatment alternative. This single-center study provides a summary of the long-term outcome after SBT in one of the largest reported patient series.
  
  
  METHODS
  All pediatric patients treated with SBT ((125)I seeds; cumulative therapeutic dose 50-65 Gy within 9 months) by our group for LGG with follow-up of more than 6 months were included. Clinical and radiologic outcome, time to progression, and overall survival were evaluated. Prognostic factors (age, sex, Karnofsky performance score, tumor volume, and histology) for survival and disease progression were investigated.
  
  
  RESULTS
  In all, 147 of 160 pediatric patients treated with SBT (from 1982 through 2009) were analyzed in detail. Procedure-related mortality was zero, and the 30-day morbidity was transient and low (5.4%). Survival rates at 5 and 10 years were 93%, and 82%, respectively, with no significant difference between WHO grades I and II tumors (median follow-up, 67.1 ± 57.7 months). Twenty-one (14.8%) of 147 patients presented with tumor relapse. The remaining 126 patients revealed complete response in 24.6%, partial response in 31.0%, and stable disease in 29.6%. Neurologic status improved (57.8%) or remained stable (23.0%). None of the evaluated factors had significant impact on the study's end points except tumor volume more than 15 mL, which caused significantly higher rates of tumor recurrence (P < .05).
  
  
  CONCLUSIONS
  We demonstrate that SBT represents a safe, minimally invasive, and highly effective local treatment option for pediatric patients with inoperable LGG WHO grades I and II.
authors.affiliation: University of Cologne, Cologne, Germany. maximilian.ruge@uk-koeln.de
authors.forename: Maximilian I
authors.initials: MI
authors.lastname: Ruge
authors.forename: Thorsten
authors.initials: T
authors.lastname: Simon
authors.forename: Bogdana
authors.initials: B
authors.lastname: Suchorska
authors.forename: Ralph
authors.initials: R
authors.lastname: Lehrke
authors.forename: Christina
authors.initials: C
authors.lastname: Hamisch
authors.forename: Friederike
authors.initials: F
authors.lastname: Koerber
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.forename: Harald
authors.initials: H
authors.lastname: Treuer
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.forename: Jürgen
authors.initials: J
authors.lastname: Voges
mesh_terms: D000293:Adolescent; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008499:Medical Records; D060787:Neoplasm Grading; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes