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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Surgical resection plus interstitial Iodine-125 radiosurgery in eloquently located WHO Grade II glioma: feasibility and outcome of a local treatment concept

Chirurgische Resektion und Interstitielle Iod-125 Radiochirurgie bei WHO Grad II Gliomen in eloquenter Lokalisation : Machbarkeit und Ergebnisse eines lokalen Behandlungskonzeptes

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  • corresponding author K. Schöller - Neurochirurgische Klinik, Klinikum der Universität München - Großhadern
  • O. Schnell - Neurochirurgische Klinik, Klinikum der Universität München - Großhadern
  • M. Ruge - Neurochirurgische Klinik, Klinikum der Universität München - Großhadern
  • J.-C. Tonn - Neurochirurgische Klinik, Klinikum der Universität München - Großhadern
  • F. W. Kreth - Neurochirurgische Klinik, Klinikum der Universität München - Großhadern

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-06.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0196.shtml

Published: May 4, 2005

© 2005 Schöller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

The current prospectively designed pilot study analysed the feasibility and outcome of a combined microsurgical/ interstitial radiosurgical approach for patients with highly eloquently located supratentorial WHO Grade II glioma.

Methods

Between 1998 and 2004, 31 patients were included in the study protocol: Tumour resection was performed as radically as possible in every patient using multimodal intraoperative stimulation techniques. Interstitial radiosurgery (IRS) was done in remaining or recurrent circumscribed tumours with a diameter ≤3.5 cm. IRS of de-novo tumours was performed three months after tumour resection. The reference dose (calculated to the boundary of the tumour) was 55 Gy and the median dose rate was 10 cGy/h. The median duration of irradiation was 26 days. Reference point for estimation of treatment effects was the date of IRS. Last follow-up was performed in November 2004. Treatment response after IRS was classified according to the Macdonald criteria (Macdonald et al., J Clin Oncol 1990 Jul; 8(7): 1277-80); Time to tumour progression and malignant transformation was estimated with the Kaplan Meier method. Any adverse sequel potentially attributable to treatment was considered as morbidity.

Results

IRS was performed in 18 patients after partial tumour resection and in 13 patients with recurrent tumours. Median follow-up was 64 months. The 5-year progression free survival was 62% and the 5-year malignant transformation rate 19%. Complete remission, partial remission and tumour control after IRS was seen in 8, 9, and 14 patients, respectively. The median KPS at the time of the last follow-up was unchanged compared to the pretreatment score. Microsurgical related transient and permanent morbidity was 47% and 10%, respectively. Transient (permanent) morbidity after IRS was 6% (0%). There was no mortality in this series.

Conclusions

IRS in combination with microsurgery is a feasible treatment concept for highly eloquently located glioma. IRS is safe and minimally invasive and offers the possibility to withhold or delay external beam radiation.