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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Interstitial radiosurgery with I-125 seeds in children with low-grade glioma

Meeting Abstract

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  • M. Trippel - Abteilung für Stereotaktische Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • D. Neuburger - Abteilung Neuropädiatrie, Universitätsklinikum Freiburg
  • R. Korinthenberg - Abteilung Neuropädiatrie, Universitätsklinikum Freiburg
  • G. Nikkhah - Abteilung für Stereotaktische Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.08-02

doi: 10.3205/09dgnc045, urn:nbn:de:0183-09dgnc0453

Published: May 20, 2009

© 2009 Trippel 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: The treatment of low-grade brain tumours is a considerable challenge, especially in children at eloquent sides. Since 1984 we treated 156 children and adolescents with interstitial radiosurgery (IRS) with I-125 seeds. The indications were symptomatic and/or progressive WHO grade I/II tumours with approximately spherical shape and a diameter up to 5 cm.

Methods: In a retrospective study patient files were analyzed and quantitative analysis in the CCT/MRT imaging was done. 94 patients fulfilled the inclusion criterion of a completely documented follow-up of at least 6 months (50m, 44f, median age 9 years). These were not different from the 62 excluded cases regarding all relevant disease parameters. There were 79 astrocytomas, 5 oligodendrogliomas, 4 oligoastrozytomas, 1 ependymoma and 5 other lesions located in the suprasellar/chiasmal region (44), thalamus or basal ganglia (18), hemispheres (15), midbrain/pineal region (13) and lower brainstem (3).

Results: In the initial Rankin-scale 9% of patients were free of symptoms, 49% were symptomatic but not disabled, 31% were slightly, 8% moderately and 2% severely disabled. 5 patients had died within a total observation period of 53.6 (6.8-171.0) months. The time until the indication of a renewed treatment (N=47, of these 18 repeated IRS) or to last follow-up was 38.4 (6.4-171.0) months. As a result of the first IRS 4 patients showed complete, 27 partial and 18 objective responses, 15 showed stable and 30 progressive disease. The response did not depend on age, sex, histology, tumour size, localisation and demarcation of the tumour (logistic regression). The necessity of repeated treatment was correlated to the initial size of the tumour. In the last available Rankin scale the number of symptom-free patients increased to 22%. 40% showed symptoms without functional impairment, 20% were slightly, 13% moderately and 3% severely disabled.

Conclusions: Due to its low invasiveness and the restricted radiation field IRS with I-125 is a very useful treatment in tumours with appropriate size and shape, especially in children and adolescents. In larger tumours repeated treatment also including different modalities can be necessary after 2 to 4 years. In our view I-125 IRS can be a useful contribution to the complex treatment of low-grade brain tumours.