gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Stereotactic iodine-125 brachytherapy for the treatment of focal brainstem gliomas WHO grades I and II: long-term outcome

Meeting Abstract

  • P. Kickingereder - Klinik für Stereotaxie und Funktionelle Neurochirurgie
  • T. Simon - Klinik für Pädiatrische Hämatologie und Onkologie, Klinikum der Universität zu Köln
  • H. Treuer - Klinik für Stereotaxie und Funktionelle Neurochirurgie
  • V. Sturm - Klinik für Stereotaxie und Funktionelle Neurochirurgie
  • M.I. Ruge - Klinik für Stereotaxie und Funktionelle Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.07.08

DOI: 10.3205/12dgnc348, URN: urn:nbn:de:0183-12dgnc3481

Published: June 4, 2012

© 2012 Kickingereder et al.
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Outline

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Objective: In the literature, microsurgical resection for accessible focal brainstem gliomas (F-BSG) World Health Organization (WHO) grades I and II is the most suggested treatment option. However, due to localization in a highly eloquent structure of the brain, resection is associated with a postoperative permanent morbidity, ranging from 12–33 %. Scarce reports have suggested stereotactic brachytherapy (SBT) with implantation of iodine-125 (125I) seeds as a treatment alternative.

Methods: Between 1993 and 2010, 47 patients (including 26 children aged <20 years) were treated with SBT (125I seeds; cumulative therapeutic dose 50–65 Gy within 9 months) for inoperable F-BSG WHO grades I and II. We evaluated procedure related complications in the early postoperative period and in the long-term run, as well as clinical outcome, progression-free survival (PFS) and survival (OS). Median follow-up was 81.6 months (range, 3.2–188.6 months).

Results: Procedure-related mortality was zero. Within 30 days after seed implantation 8 patients (17.0%) showed transient neurological deficits and 2 patients (4.3%) permanently deteriorated (mild hemiparesis / tremor in one patient, 6th nerve palsy in the other). Radiogenic complications, in terms of space occupying cysts occurred in 6 patients (12.8%) after a median of 28.5 months (range, 13.6–49.9 months), requiring surgical intervention (cyst evacuation and/or resection). Nine patients (19.1%) presented with tumour relapse after a median of 56.6±33.2 months (range, 7.9–118.0 months). The remaining 39 patients revealed complete response in 23.4 %, partial response in 29.8%, and stable disease in 27.7%. The actuarial PFS rates were 97.7±2.2%, 92.6±4.1%, 80.7±6.7%, and 61.5±10.5% at 1, 2, 5, and 10 years, respectively. The corresponding OS rates were 100%±0.0% (1 yr and 2 yrs), 97.4% ±2.6% (5 yrs), and 87.6% ±7.0% (10 yrs).

Conclusions: SBT is a comparatively safe, minimally invasive, and highly effective local treatment option for patients with F-BSG WHO grades I and II, and deserves further evaluation in prospective randomized trials.