title: Stereotactic iodine-125 brachytherapy for treatment of inoperable focal brainstem gliomas of WHO grades I and II: feasibility and long-term outcome.
abstract: Microsurgical resection is the most frequently suggested treatment option for accessible focal brainstem gliomas (F-BSG) of World Health Organization (WHO) grades I and II. Because of their location in the highly eloquent brain, however, resection is associated with permanent postoperative morbidity, ranging from 12 to 33 %. Only a few reports have suggested stereotactic brachytherapy (SBT) with implantation of iodine-125 seeds as a local treatment alternative. Between 1993 and 2010, 47 patients were treated with SBT (iodine-125 seeds; cumulative surface dose 50-65 Gy) for inoperable F-BSG, WHO grades I and II, in one of the largest reported patient series. We evaluated procedure-related complications, clinical outcome, and progression-free and overall survival (PFS, OS). Median follow-up was 81.6 months. Procedure-related mortality was zero. Within 30 days of seed implantation six patients (12.8 %) had transient neurological deficits. Two patients (4.3 %) deteriorated permanently. Space-occupying cysts occurred in six patients (12.8 %) after a median of 28.5 months, and required surgical intervention. Nine patients (19.1 %) presented with tumor relapse after a median of 56.6 months (range 7.9-118.0 months). For the remaining 38 patients complete response was observed for 23.4 %, partial response for 29.8 %, and stable disease for 27.7 %. Actuarial PFS was 97.7 ± 2.2, 92.8 ± 4.0, 81.2 ± 6.5, and 62.0 ± 10.4 % after 1, 2, 5, and 10 years, respectively. Corresponding OS was 100 ± 0.0 % (1 and 2 years), 97.4 ± 2.6 % (5 years), and 87.6 ± 7.0 % (10 years). SBT is a comparatively safe, minimally invasive, and highly effective local treatment option for patients with inoperable F-BSG WHO grades I and II; it merits further evaluation in prospective randomized trials.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Straße 62 Main Clinic Building 11th Floor, 50937, Cologne, Germany. maximilian.ruge@uk-koeln.de
authors.forename: Maximilian I
authors.initials: MI
authors.lastname: Ruge
authors.forename: Philipp
authors.initials: P
authors.lastname: Kickingereder
authors.forename: Thorsten
authors.initials: T
authors.lastname: Simon
authors.forename: Harald
authors.initials: H
authors.lastname: Treuer
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001918:Brachytherapy / Q000379:methods*; D020295:Brain Stem Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005910:Glioma / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014944:World Health Organization; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes