title: Surgical Technique and Clinically Relevant Resection Cavity Dynamics Following Implantation of Cesium-131 (Cs-131) Brachytherapy in Patients With Brain Metastases.
abstract: Cesium-131 (Cs-131) brachytherapy is used to reduce local recurrence of resected brain metastases. In order to ensure dose homogeneity and reduce risk of radiation necrosis, inter-seed distance and cavity volume must remain stable during delivery.
  
  
  
  To investigate the efficacy of the "seeds-on-a-string" technique with intracavitary fibrin glue in achieving cavity volume stability.
  
  
  
  We placed intra-operative Cs-131 brachytherapy in 30 cavities post-resection of brain metastases. Seeds-on-a-string were placed like barrel staves within the cavity with fibrin glue. Serial MRI imaging occurred post-operatively. Pre-operative tumor volumes were compared with post-operative cavity volumes to evaluate volume stability. Thirty patients who underwent post-resective stereotactic radiosurgery (SRS) were used as a control group for volumetric comparison.
  
  
  
  Cs-131 and SRS patients exhibited consistent cavity shrinkage over the median 110-day follow-up (p<.001), with total median shrinkage of 56.5% (Cs-131) and 84.8% (SRS). During the first month when ~88% of Cs-131 dosage is delivered, however, there was non-significant volume decrease in the Cs-131 group (median 22.0%; p=.063), while SRS patients showed significantly more shrinkage (46.7%; p=.042). No events of radiation necrosis occurred in either group.
  
  
  
  Cs-131 patients exhibited significantly less cavity shrinkage than SRS patients during the first critical month with 88% Cs-131 dose delivery. This significant difference in shrinkage suggests that the intracavitary seeds-on-a-string technique facilitates increased cavity stability, promoting more homogenous dose delivery.
authors: Stich Radiation Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.|Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: A Gabriella
authors: AG
authors: Wernicke
authors: Weill Cornell Medical College, New York, New York.
authors: Stefanie P
authors: SP
authors: Lazow
authors: Stich Radiation Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Shoshana
authors: S
authors: Taube
authors: Stich Radiation Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Menachem Z
authors: MZ
authors: Yondorf
authors: Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Ilhami
authors: I
authors: Kovanlikaya
authors: Stich Radiation Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Dattatreyudu
authors: D
authors: Nori
authors: Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College, New York, New York.
authors: Paul
authors: P
authors: Christos
authors: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: John A
authors: JA
authors: Boockvar
authors: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Susan
authors: S
authors: Pannullo
authors: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Philip E
authors: PE
authors: Stieg
authors: Department of Otorhinolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.|Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors: Theodore H
authors: TH
authors: Schwartz
mesh_terms: D001918:Brachytherapy; D001921:Brain; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D002588:Cesium Radioisotopes / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002588:Cesium Radioisotopes; C000614985:Cesium-131
keywords: brachytherapy; brain metastases; cavity volume dynamics; cesium-131 (Cs-131); radiotherapy; resection cavity