Strahlentherapie und Onkologie

, Volume 187, Issue 1, pp 7–14 | Cite as

Comparison of Stereotactic Brachytherapy (125Iodine Seeds) with Stereotactic Radiosurgery (LINAC) for the Treatment of Singular Cerebral Metastases

  • Maximilian I. Ruge
  • Martin Kocher
  • Mohammad Maarouf
  • Christina Hamisch
  • Harald Treuer
  • Jürgen Voges
  • Volker Sturm
Original Article

Abstract

Purpose:

To compare stereotactic brachytherapy (SBT) with stereotactic radiosurgery (SRS) for treating singular cerebral metastases, regarding feasibility, complications, cerebral disease control, and survival.

Patients and Methods:

For this retrospective, single-center study, all patients treated for newly diagnosed, untreated singular cerebral metastasis with SBT using 125iodine seeds (cumulative tumor surface dose 50 Gy, applied for 42 days) were compared with patients receiving LINAC-based SRS for the same indication. Survival and actuarial local and distant disease control were evaluated using univariate Kaplan–Meier estimates and Cox regression. Results were compared using Student’s t test and the χ2 test.

Results:

A total of 142 patients treated with SRS were compared with 77 patients undergoing SBT. No significant differences were observed between epidemiological and disease-related features (p > 0.05), except a lower KPS (p < 0.007) and a larger tumor volume (p < 0.001) in the SBT group. Neither median survival (LINAC-SRS vs. SBT = 8.1 vs. 8.0 months, respectively) nor actuarial local/distant cerebral disease control after 12 months showed significant differences (93.6% vs. 96.7% / 42.4% vs. 46.4%). There was no treatment-related mortality and no permanent grade 3 or 4 CNS toxicity (RTOG/EORTC CNS toxicity criteria).

Conclusion:

For the treatment of singular cerebral metastasis, SBT represents a safe, minimally invasive, and effective local treatment option with results comparable to SRS regarding survival and cerebral disease control. Its advantage is that it allows histological (re-)evaluation and treatment within one stereotactic procedure and, compared to microneurosurgery, is almost unrestricted regarding tumor localization. Furthermore, larger metastases can be treated than with SRS. SBT, therefore, represents an alternative local treatment in selected cases.

Key Words

Stereotaxy 125Iodine seeds Stereotactic brachytherapy (SBT) Singular brain metastases Stereotactic radiosurgery (SRS) 

Vergleich der stereotaktischen Brachytherapie mittels Jod-125-Seeds mit der stereotaktischen Radiochirurgie (LINAC) für die Behandlung singulärer zerebraler Metastasen

Zusammenfassung

Ziel:

Vergleich der stereotaktischen Radiochirurgie (SRS) mit stereotaktisch geführter Jod-125-Seedimplantation zur Brachytherapie (SBT) zur Behandlung neu diagnostizierter, unbehandelter singulärer zerebraler Metastasen bezüglich Durchführbarkeit, Komplikationen, zerebraler Tumorkontrolle und Überleben.

Patienten und Methodik:

Für diese retrospektive Studie verglichen wir Behandlungsergebnisse von Patienten mit singulären zerebraler Metastasen, die mittels SBT (Jod-125-Seeds, kumulative Tumoroberflächendosis 50 Gy appliziert über 42 Tage) therapiert wurden, mit solchen, die LINAC-basierte SRS erhielten. Überleben, aktuarische lokale und distante Kontrolle der cerebralen Metastasen nach 12 Monaten wurden mittels Kaplan–Meier ermittelt und Ergebnisse mittels t-Test und Chi-Quadrat Test ausgewertet.

Ergebnisse:

142 SRS-behandelte Patienten wurden mit 77 SBT-therapierten verglichen. Bis auf schlechteren KPS (p < 0.007) und größeres Tumorvolumen (p < 0,001) in der SBT-Gruppe unterschieden sich epidemiologische und krankheitsspezifische Merkmale nicht signifikant (p > 0,05). Weder das mediane Überleben (SRS vs. SBT = 8,1 versus 8,0 Monate) noch die aktuarische lokale/ distante Tumorkontrolle (93,6% vs. 96,7%/42,4% vs. 46,4%) zeigten signifikante Unterschiede. Es gab keine behandlungsassoziierte Mortalität und keine permanenten Grad-3- und -4-Schädigungen (ZNS-Toxizitätskriterien der RTOG/EORTC).

Schlussfolgerung:

SBT stellt eine sichere, minimal-invasive und effektive Methode zur lokalen Behandlung singulärer zerebraler Metastasen dar. Vorteilhaft ist die Kombinationsmöglichkeit von histologischer Diagnostik und Behandlung innerhalb einer Operationssitzung. Die Ergebnisse sind bezüglich Überleben und zerebraler Tumorkontrolle mit denen nach SRS vergleichbar. Im Gegensatz zur Mikro-Neurochirurgie bestehen kaum Restriktionen bezüglich Tumorlokalisation. Im Vergleich zur SRS können auch größere Metastasen behandelt werden. Daher stellt SBT für ausgewählte Fälle eine alternative lokale Behandlungsmethode dar.

Schlüsselwörter

Stereotaktische Radiochirugie Jod-125-Seeds Stereotaktische Brachytherapie Singuläre zerebrale Metastasen 

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Copyright information

© Urban &amp; Vogel, Muenchen 2010

Authors and Affiliations

  • Maximilian I. Ruge
    • 1
    • 4
  • Martin Kocher
    • 2
  • Mohammad Maarouf
    • 1
  • Christina Hamisch
    • 1
  • Harald Treuer
    • 1
  • Jürgen Voges
    • 3
  • Volker Sturm
    • 1
  1. 1.Department of Stereotactic and Functional NeurosurgeryUniversity of CologneCologneGermany
  2. 2.Department of Radiation OncologyUniversity of CologneCologneGermany
  3. 3.Department of Stereotactic NeurosurgeryUniversity of MagdeburgMagdeburgGermany
  4. 4.Department of Stereotactic and Functional NeurosurgeryUniversity of CologneCologneGermany

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