Skip to main content
SpringerLink
Log in

Pineal Parenchymal Tumors

Management with Interstitial Iodine-125 Radiosurgery

Pinealisparenchymtumoren. Behandlung durch interstitielle Radiochirurgie mittels Jod-125

  • Current Discussion
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose:

To evaluate the efficacy of interstitial radiosurgery (IRS) for pineal parenchymal tumors (PPTs).

Patients and Methods:

18 consecutively admitted patients (twelve male and six female, age range 6–68 years, median age 34 years) with PPTs (eight pineocytomas, ten malignant PPTs) were treated at the authors’ institution with IRS using stereotactically guided iodine-125 seed implantation (125I-IRS) as either primary or salvage therapy. The cumulative tumor surface dose ranged from 40 to 64 Gy. Adjuvant radiotherapy of the whole brain or the craniospine was done in patients with grade III and grade IV PPT. The median follow-up period was 57.4 months (range 6–134 months).

Results:

Overall actuarial 5- and 8-year survival rates after IRS were 100% and 86% for pineocytomas, and the overall actuarial 5-year survival rate was 78% for high-grade PPTs. Follow-up magnetic resonance imaging showed complete remission in 72% (13/18) and partial remission in 28% (5/18) of the cases. One patient developed an out-of-field relapse 4 years after partial remission of a pineocytoma, which had already been treated with IRS. There was no treatment-related mortality. Treatment-related morbidity occurred in two patients only.

Conclusion:

This study indicates that stereotactic 125I-IRS for the management of PPTs is quite efficient and safe. Due to the low rate of side effects, IRS may develop into an attractive alternative to microsurgery in de novo diagnosed pineocytomas. In malignant PPTs, IRS may be routinely applied in a multimodality treatment schedule supplementary to conventional irradiation.

Zusammenfassung

Ziel:

Die Wirksamkeit der stereotaktischen interstitiellen Radiochirurgie (IRS) zur Behandlung von Pinealisparenchymtumoren (PPTs) wurde analysiert.

Patienten und Methodik:

18 Patienten (zwölf männlich und sechs weiblich, Alter 6–68 Jahre, medianes Alter 34 Jahre) mit einem PPT (acht Pineozytome, zehn maligne PPTs) wurden in der Klinik der Autoren durch eine stereotaktisch geführte interstitielle Radiochirurgie mittels Implantation von Jod-125-Seeds (125I-IRS) behandelt. Die Behandlung erfolgte entweder als Primar- oder als Salvage-Therapie. Die kumulative Tumoroberflächendosis variierte von 40 bis 64 Gy. Adjuvante Ganzhirnbestrahlung oder Bestrahlung der Wirbelsäule wurde bei den Patienten mit malignen PPTs durchgeführt. Die mediane Nachbeobachtungszeit betrug 57,4 Monate (6–134 Monate).

Ergebnisse:

Die 5- und 8-Jahres-Uberlebensraten nach IRS für Pineozytome betrugen 100% bzw. 86%, und die 5-Jahres-Uberlebensrate nach IRS für die höhergradigen PPTs lag bei 78%. Eine komplette Remission wurde in 72% der Fälle (13/18) und eine partielle Remission in 28% der Fälle (5/18) erzielt. Ein Patient entwickelte 4 Jahre nach partieller Remission eines Pineozytoms ein „out-of-field“-Rezidiv. Dieses Rezidiv wurde ebenfalls mittels stereotaktisch geführter IRS behandelt. Es wurde keine behandlungsbedingte Mortalität beobachtet. Eine behandlungsbedingte Morbidität trat bei zwei Patienten auf.

Schlussfolgerung:

Die Studie zeigt, dass die Behandlung von PPTs durch stereotaktisch geführte 125I-IRS sicher und effektiv ist. Aufgrund der geringen Nebenwirkungen kann sich diese Behandlung zu einer guten Alternative zur Mikrochirurgie bei de novo diagnostizierten Pineozytomen entwickeln. Bei malignen PPTs kann diese Methode als Ergänzung in ein multimodales Behandlungskonzept einbezogen werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anonymous. Report of Brain Tumor Registry of Japan (1969–1993). Neurol Med Chir (Tokyo) 2000;40:1–106.

  2. Apuzzo ML, Chandrasoma PT, Cohen D, et al. Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 1987;20:930–7.

    Article  PubMed  CAS  Google Scholar 

  3. Apuzzo ML, Chandrasoma PT, Zelman V, et al. Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 1984;15:502–8.

    Article  PubMed  CAS  Google Scholar 

  4. Barlas O, Bayindir C, Imer M, et al. Non-resective management of pineoblastoma. Minim Invasive Neurosurg 2000;43:163–70.

    Article  PubMed  CAS  Google Scholar 

  5. Bruce JN, Stein BM. Surgical management of pineal region tumors. Acta Neurochir (Wien) 1995;134:130–5.

    Article  CAS  Google Scholar 

  6. Chang SM, Lillis-Hearne PK, Larson DA, et al. Pineoblastoma in adults. Neurosurgery 1995;37:383–90, discussion 390-1.

    Article  PubMed  CAS  Google Scholar 

  7. Christ G, Denninger D, Dohm OS, et al. Craniospinal radiotherapy in an advanced technique. Strahlenther Onkol 2008;184:530–5.

    Article  PubMed  Google Scholar 

  8. Dempsey PK, Lunsford LD. Stereotactic radiosurgery for pineal region tumors. Neurosurg Clin N Am 1992;3:245–53.

    PubMed  CAS  Google Scholar 

  9. Deshmukh VR, Smith KA, Rekate HL, et al. Diagnosis and management of pineocytomas. Neurosurgery 2004;55:349–57.

    Article  PubMed  Google Scholar 

  10. Duffner PK, Cohen ME, Sanford RA, et al. Lack of efficacy of postoperative chemotherapy and delayed radiation in very young children with pineoblastoma. Pediatric Oncology Group. Med Pediatr Oncol 1995;25:38–44.

    Article  PubMed  CAS  Google Scholar 

  11. Edwards MS, Hudgins RJ, Wilson CB, et al. Pineal region tumors in children. J Neurosurg 1988;68:689–97.

    Article  PubMed  CAS  Google Scholar 

  12. El Majdoub F, Brunn A, Berthold F, et al. Stereotactic interstitial radiosurgery for intracranial Rosai-Dorfman disease. A novel therapeutic approach. Strahlenther Onkol 2009;185:109–12.

    Article  PubMed  Google Scholar 

  13. Fauchon F, Jouvet A, Paquis P, et al. Parenchymal pineal tumors: a clinicopathological study of 76 cases. Int J Radiat Oncol Biol Phys 2000;46:959–68.

    Article  PubMed  CAS  Google Scholar 

  14. Fuller BG, Kapp DS, Cox R. Radiation therapy of pineal region tumors: 25 new cases and a review of 208 previously reported cases. Int J Radiat Oncol Biol Phys 1994;28:229–45.

    Article  PubMed  CAS  Google Scholar 

  15. Gilheeney SW, Saad A, Chi S, et al. Outcome of pediatric pineoblastoma after surgery, radiation and chemotherapy. J Neurooncol 2008;89:89–95.

    Article  PubMed  Google Scholar 

  16. Hasegawa T, Kondziolka D, Hadjipanayis C, et al. The role of radiosurgery for the treatment of pineal parenchymal tumors. Neurosurgery 2002;51:880–9.

    Article  PubMed  Google Scholar 

  17. Jakacki RI, Zeltzer PM, Boyett JM, et al. Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Children’s Cancer Group. J Clin Oncol 1995;13:1377–83.

    PubMed  CAS  Google Scholar 

  18. Jooma R, Kendall BE. Diagnosis and management of pineal tumors. J Neurosurg 1983;58:654–65.

    Article  PubMed  CAS  Google Scholar 

  19. Jouvet A, Fevre-Montange M, Besancon R, et al. Structural and ultrastructural characteristics of human pineal gland, and pineal parenchymal tumors. Acta Neuropathol (Berl) 1994;88:334–48.

    Article  CAS  Google Scholar 

  20. Kano H, Niranjan A, Kondziolka D, et al. Role of stereotactic radiosurgery in the management of pineal parenchymal tumors. Prog Neurol Surg 2009;23:44–58.

    Article  PubMed  Google Scholar 

  21. Koot RW, Maarouf M, Hulshof MC, et al. Brachytherapy: results of two different therapy strategies for patients with primary glioblastoma multiforme. Cancer 2000;88:2796–802.

    Article  PubMed  CAS  Google Scholar 

  22. Kreth FW, Schatz CR, Pagenstecher A, et al. Stereotactic management of lesions of the pineal region. Neurosurgery 1996;39:280–9, discussion 289-91.

    Article  PubMed  CAS  Google Scholar 

  23. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol (Berl) 2007;114:97–109.

    Article  Google Scholar 

  24. Lutterbach J, Fauchon F, Schild SE, et al. Malignant pineal parenchymal tumors in adult patients: patterns of care and prognostic factors. Neurosurgery 2002;51:44–55.

    Article  PubMed  Google Scholar 

  25. MacDonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant gliomas. J Clin Oncol 2003;21:3547–9.

    Article  Google Scholar 

  26. Marsh WR, Laws ER. Shunting and irradiation of pineal tumors. Clin Neurosurg 1985;32:384–96.

    PubMed  CAS  Google Scholar 

  27. Nieder C, Astner ST, Grosu AL, et al. The role of postoperative radiotherapy after resection of a single brain metastasis. Combined analysis of 643 patients. Strahlenther Onkol 2007;183:576–80.

    Article  PubMed  Google Scholar 

  28. Ott OJ, Lotter M, Fietkau R, Strnad V. Accelerated partial-breast irradiation with interstitial implants. Analysis of factors affecting cosmetic outcome. Strahlenther Onkol 2009;185:170–6.

    Article  PubMed  Google Scholar 

  29. Patil AA, Good R, Bashir R, Etemadrezaie H. Nonresective treatment of pineoblastoma: a case report. Surg Neurol 1995;44:386–91, discussion 390-1.

    Article  PubMed  CAS  Google Scholar 

  30. Peters N, Wieners G, Pech M, et al. CT-guided interstitial brachytherapy of primary and secondary lung malignancies. Results of a prospective phase II trial. Strahlenther Onkol 2008;184:296–301.

    Article  PubMed  Google Scholar 

  31. Popovic EA, Kelly PJ. Stereotactic procedures for lesions of the pineal region. Mayo Clin Proc 1993;68:965–70.

    PubMed  CAS  Google Scholar 

  32. Regis J, Bouillot P, Rouby-Volot F, et al. Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery 1996;39:907–12, discussion 912-4.

    Article  PubMed  CAS  Google Scholar 

  33. Schild SE, Scheithauer BW, Schomberg PJ, et al. Pineal parenchymal tumors. Clinical, pathologic, and therapeutic aspects. Cancer 1993;72:870–80.

    Article  PubMed  CAS  Google Scholar 

  34. Sterzing F, Grehn C, Dinkel J, et al. Severe reversible toxic encephalopathy induced by cisplatin in a patient with cervical carcinoma receiving combined radiochemotherapy. Strahlenther Onkol 2007;183:487–9.

    Article  PubMed  Google Scholar 

  35. Sturm V, Pastyr O, Schlegel W, et al. Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations. Acta Neurochir (Wien) 1983;68:11–7.

    Article  CAS  Google Scholar 

  36. Treuer H, Klein D, Maarouf M, et al. Accuracy and conformity of stereotactically guided interstitial brain tumour therapy using I-125 seeds. Radiother Oncol 2005;77:202–9.

    Article  PubMed  Google Scholar 

  37. Tselis N, Kolotas C, Birn G, et al. CT-guided interstitial HDR brachytherapy for recurrent gliobalstoma multiforme. Long-term results. Strahlenther Onkol 2007;183:563–70.

    Article  PubMed  Google Scholar 

  38. Voges J, Treuer H, Schlegel W, et al. Interstitial irradiation of cerebral gliomas with stereotactically implanted iodine-125 seeds. Acta Neurochir Suppl 1993;58:108–11.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Stereotactic and Functional Neurosurgery, University of Cologne, Köln, Germany

    Mohammad Maarouf, Christian Bührle, Jürgen Voges, Ralph Lehrke, Stefan Hunsche, Harald Treuer & Volker Sturm

  2. Department of General Neurosurgery, University of Cologne, Köln, Germany

    Faycal El Majdoub MD

  3. Department of Radiation Oncology, University of Cologne, Köln, Germany

    Martin Kocher

  4. Associate Professor, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Köln, Germany

    Mohammad Maarouf

  5. Department of General Neurosurgery, University of Cologne Germany, Kerpener Straße 62, 50937, Köln, Germany

    Faycal El Majdoub MD

Authors
  1. Mohammad Maarouf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Faycal El Majdoub MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Bührle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jürgen Voges
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ralph Lehrke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Kocher
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefan Hunsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Harald Treuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Volker Sturm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Mohammad Maarouf or Faycal El Majdoub MD.

Additional information

Both authors contributed equally to the study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maarouf, M., El Majdoub, F., Bührle, C. et al. Pineal Parenchymal Tumors. Strahlenther Onkol 186, 127–134 (2010). https://doi.org/10.1007/s00066-010-2096-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-010-2096-3

Key Words

Schlüsselwörter

Search

Navigation