Artikel
Stereotactic 125Iodine brachytherapy for the treatment of singular cerebral metastases – Closing the gap?
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Veröffentlicht: | 16. September 2010 |
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Objective: To report ont stereotactic 125Iodine brachytherapy (SBT) for the treatment of singular cerebral metastases regarding feasibility, survival and cerebral disease control, in order to identify prognostic factors and to compare results with other local treatment methods.
Methods: Complications, survival (overall and separated by recursive partitioning analysis (RPA) classes), local and distant disease control were evaluated retrospectively in 90 patients. Prognostic factors were identified by forming subgroups of patients: age, KPS, status of extracranial disease, interval between initial diagnosis, absence/presence of prior whole brain radiation therapy (WBRT), localization, morphology and tumor volume.
Results: Median survival was 8.5 months for all and 18.1 months for RPA class 1 patienst, respectively. There was no treatment-related mortality and morbidity was transient and low (3.3%). After a period of one year, local recurrence was found in 3.6% and new distant cerebral disease in 46.4%. KPS≥70 (p<0.002), stable systemic disease (p<0.02), RPA class 1 (p<0.02) and a prolonged (<12months) interval between initial diagnosis and SBT improved survival significantly. There was no significant influence of previous WBRT on survival or cerebral disease recurrence.
Conclusions: SBT represents a safe, minimal invasive local treatment option which is equally effective regarding survival and cerebral disease control in comparison to SRS and microsurgery. It allows histological (re)-evaluation and treatment within one stereotactic operation. Since it is less restricted by tumor localization or size, it is an important step forward in the local treatment options and based on its favorable biological irradiation effect, SBT does not narrow additional irradiation treatment in case of disease recurrence.