Artikel
Stereotactic iodine-125 brachytherapy for the treatment of focal brainstem gliomas WHO grades I and II: long-term outcome
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Autoren
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P. Kickingereder
- Klinik für Stereotaxie und Funktionelle Neurochirurgie
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T. Simon
- Klinik für Pädiatrische Hämatologie und Onkologie, Klinikum der Universität zu Köln
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H. Treuer
- Klinik für Stereotaxie und Funktionelle Neurochirurgie
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V. Sturm
- Klinik für Stereotaxie und Funktionelle Neurochirurgie
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M.I. Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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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.
