title: Stereotactic iodine-125 brachytherapy for the treatment of WHO grades II and III gliomas located in the central sulcus region.
abstract: BACKGROUND
  Resection of gliomas located in eloquent brain areas remains a neurosurgical challenge. The reported incidence of transient or permanent neurological deficits after microsurgery in eloquent brain ranges 20%-100%, or 0%-47% among contemporary neurosurgical series. The aim of this study was to assess the feasibility of stereotactic brachytherapy (SBT) as a local treatment alternative to microsurgical resection for patients with gliomas in highly eloquent areas, located in the central sulcus region (CSR).
  
  
  METHODS
  Between 1997 and 2010, 60 patients with World Health Organization (WHO) grades II and III gliomas located in the CSR were treated with SBT (iodine-125 seeds; cumulative therapeutic dose, 50-65 Gy). Following SBT, WHO grade III glioma patients additionally received percutaneous radiotherapy (median boost dose, 25.2 Gy). We evaluated procedure-related complications, clinical outcome, and progression-free survival.
  
  
  RESULTS
  Procedure-related mortality was zero. Within 30 days of SBT, 3 patients (5%) had transient neurological deficits, and 8 patients (13%) had temporarily increased seizure activity. One patient (1.6%) deteriorated permanently. Space-occupying cysts (6 patients) and radiation necrosis (1 patient) developed after a median of 38 months and required surgical intervention. Seizure activity, rated 12 months following SBT, decreased in 82% of patients (Engel classes I-III). Median progression-free survivals were 62.2 ± 19.7 months (grade II gliomas) and 26.1 ± 17.9 months (grade III gliomas).
  
  
  CONCLUSIONS
  Compared with microsurgical resection, SBT harbors a low risk of procedural complications, is minimally invasive, and seems to be an effective local treatment option for patients with inoperable, eloquent WHO grade II and III gliomas in the CSR. However, the value of SBT for treating gliomas still needs to be determined in prospective, randomized studies.
authors.affiliation: Corresponding Author: Maximilian I. Ruge, MD, Department of Stereotactic and Functional Neurosurgery, University Clinics of Cologne, Kerpener Straße 62, 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: Stefan
authors.initials: S
authors.lastname: Grau
authors.forename: Franziska
authors.initials: F
authors.lastname: Dorn
authors.forename: Norbert
authors.initials: N
authors.lastname: Galldiks
authors.forename: Harald
authors.initials: H
authors.lastname: Treuer
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002540:Cerebral Cortex / Q000528:radiation effects* / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011446:Prospective Studies; D013238:Stereotaxic Techniques; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes
keywords: central sulcus region; eloquent gliomas; stereotactic iodine-125 brachytherapy, SBT
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