gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Stereotactic brachytherapy with 125Iodine seeds (SBT) for the treatment of inoperable low grade gliomas in children: Long-term outcome of 147 patients

Meeting Abstract

  • M.I. Ruge - Klinik für Stereotaxie und Funktionelle Neurchirurgie, Klinikum der Universität zu Köln
  • T. Simon - Klinik für Pädiatrische Hämatologie und Onkologie, Klinikum der Universität zu Köln
  • B. Suchorska - Neurochirurgische Klinik, Klinikum Großhadern, Universität München
  • R. Lehrke - Abteilung für Stereotaktische Neurochirurgie, St. Barbara Klinik Hamm
  • C. Hamisch - Klinik für Stereotaxie und Funktionelle Neurchirurgie, Klinikum der Universität zu Köln
  • H. Treuer - Klinik für Stereotaxie und Funktionelle Neurchirurgie, Klinikum der Universität zu Köln
  • F. Berthold - Klinik für Pädiatrische Hämatologie und Onkologie, Klinikum der Universität zu Köln
  • V. Sturm - Klinik für Stereotaxie und Funktionelle Neurchirurgie, Klinikum der Universität zu Köln
  • J. Voges - Klinik für Stereotaktische Neurochirurgie, Universität Magdeburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.07.05

DOI: 10.3205/11dgnc149, URN: urn:nbn:de:0183-11dgnc1493

Published: April 28, 2011

© 2011 Ruge 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

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Objective: Resection is widely considered as the gold standard for the treatment of Low Grade Gliomas (LGG) WHO Grade I & II in childhood. However, approximately half of these patients are inoperable due to tumour localization in highly eloquent brain areas. Scarce reports have suggested stereotactic brachytherapy (SBT) with implantation of 125Iodine seeds as a safe and effective local treatment alternative. This single-centre study reports the long-term outcome after SBT in one of the largest reported series.

Methods: All paediatric patients treated in our institution with SBT (125Iodine seeds, permanent implantation, surface dose 50–65 Gy) for LGG WHO Grade I & II with a follow-up >6 months were included. Clinical and radiological outcome, time to progression and overall survival were retrospectively evaluated. Prognostic factors (age, gender, Karnofsky Performance Status (KPS), tumor volume, histology) for survival and disease progression were investigated. For statistical analysis, Kaplan-Meier estimates, Log-rank and χ2-test were used.

Results: 147 patients underwent SBT in our institution (1992–2009). There was no procedure-related mortality. The 30-day morbidity was transient and low (5.4%). Survival rates at 5 and 10 years were 93%, and 82%, respectively, for the entire population with no significant difference between WHO grade I & II (median follow-up 67.1 ± 57.7 months). 21/147 patients (14,3%) presented with tumor relapse; 11 died after multimodal treatment for malignant tumor transformation. The remaining 126 patients revealed complete response in 27.8%, partial response in 34.9% and stable disease 33.3%. Neurological status improved in 57.8% or remained stable in 23.0%. The variables age, gender, KPS and histology had no significant impact on the endpoints of the study. Only tumor volume > 15ml was significantly associated with a higher rate of tumor recurrence (p < 0.05).

Conclusions: We demonstrate that SBT represents a safe, minimal invasive and highly effective local treatment option for patients with inoperable LGG WHO grade I & II.