title: Early treatment of complex located pediatric low-grade gliomas using iodine-125 brachytherapy alone or in combination with microsurgery.
abstract: To analyze efficacy, functional outcome, and treatment toxicity of low-dose rate I-125 brachytherapy (SBT) alone or in combination with best safe resection (in case of larger tumor volumes) as first-line treatment for pediatric low-grade gliomas (PLGGs) not suitable for complete resection. Consecutively treated (2000-2014) complex located circumscribed WHO grade I/II PLGGs were included. For small tumors (≤4 cm in diameter) SBT alone was performed; for larger tumors best safe resection and subsequent SBT was chosen. Temporary Iodine-125 seeds were used (median reference dose: 54 Gy). Treatment response was estimated with the modified MacDonald criteria. Analysis of functional outcome included ophthalmological, endocrinological and neurological evaluation. Survival was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from proportional hazards models. Toxicity was categorized according to the Common Terminology Criteria for Adverse Events. Fifty-eight patients were included treated either with SBT alone (n = 39) or with SBT plus microsurgery (n = 19). Five-year progression-free survival was 87%. Two patients had died due to tumor progression. Among survivors, improvement/stabilization/deterioration of functional deficits was seen in 20/14/5 patients, respectively. Complete/partial response had beneficial impact on functional scores (P = 0.02). The 5-year estimated risk to receive adjuvant radiotherapy/chemotherapy was 5.2%. The overall early (delayed) toxicity rate was 8.6% (10.3%), respectively. No permanent morbidity occurred. In complex located PLGGs, early SBT alone or combined with best safe resection preserves/improves functional scores and results in tumor control rates usually achieved with complete resection. Long-term analysis is necessary for confirmation of these results.
authors.affiliation: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Kunz
authors.affiliation: Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Silke B
authors.initials: SB
authors.lastname: Nachbichler
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Ertl
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Fesl
authors.affiliation: Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Rupert
authors.initials: R
authors.lastname: Egensperger
authors.affiliation: Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
authors.affiliation: Department of Pediatric Oncology and Hematology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Schmid
authors.affiliation: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Joerg Christian
authors.initials: JC
authors.lastname: Tonn
authors.affiliation: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Peraud
authors.affiliation: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Kreth
mesh_terms: D000293:Adolescent; D001918:Brachytherapy / Q000379:methods*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008866:Microsurgery; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes
keywords: Best safe resection; complex tumor location; functional outcome; low-dose rate I-125 SBT; pediatric low-grade glioma