title: Interstitial brachytherapy with iodine-125 seeds for low grade brain stem gliomas in adults: diagnostic and therapeutic intervention in a one-step procedure.
abstract: OBJECTIVE
  To report on iodine-125 (I125) interstitial irradiation in the treatment of low grade brain stem gliomas in adults.
  
  
  METHODS
  Ten patients with well-circumscribed lesions of the brainstem and histological confirmation of low grade glioma treated with stereotactically implanted I-125 seed in our department between 1995 and 2012 were retrospectively analyzed.
  
  
  RESULTS
  In 9 patients the lesion was treated with one I-125 seed and in one patient, 2 spatial separated lesions were implanted, therefore a total of 11 I-125 seeds were implanted. The mean volume of the 11 lesions was 2.76 ml (range: 0.5-7.2 ml), mean activity of the seeds was 6.23 mCi (range: 1.5-11.1 mCi), mean duration of irradiation was 28.5 days (range: 21-41 days) and mean effective dose rate was 9.16 cGy/h (range: 6.2-12 cGy/h). The 30 days perioperative morbidity and mortality rate was 0%. Median follow up was 72.5 month (range 5-168 months). Six of ten patients were free of progression until last follow up.
  
  
  CONCLUSIONS
  In our experience at the University Clinic in Freiburg Germany, interstitial radiosurgery based on MRI is a safe and effective method to diagnose and treat low grade gliomas of the brain stem. Furthermore randomized studies are needed to confirm the therapeutic impact of this method in comparison to external beam radiation of brain stem gliomas.
authors: Division of Stereotactic Neurosurgery, Department of General Neurosurgery, University Medical Center Freiburg, Freiburg, Germany. william.contreras@uniklinik-freiburg.de
authors: William Omar Contreras
authors: WO
authors: Lopez
authors: Michael
authors: M
authors: Trippel
authors: Soroush
authors: S
authors: Doostkam
authors: Thomas
authors: T
authors: Reithmeier
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000532:radiotherapy; D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D002528:Cerebellar Neoplasms / Q000532:radiotherapy; D059248:Chemoradiotherapy; D017809:Fatal Outcome; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020649:Pulvinar / Q000473:pathology; D013238:Stereotaxic Techniques; D016019:Survival Analysis
chemical_list: D007457:Iodine Radioisotopes
keywords: Interstitial brachytherapy; Iodine-125 seeds; Isodose distribution; Low grade brainstem gliomas in adults; Radioactive isotopes and radiation dose; University Clinic Freiburg Germany