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Incidence of late radiation necrosis with transient mass effect after interstitial low dose rate radiotherapy for cerebral gliomas

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Summary

Late radiation necroses constitute a hazard in low dose rate interstitial irradiation for inoperable gliomas. An incidence of 40% (8/20 patients) was found after permanent implantation of Iodine-125 seeds. This finding may even underestimate the real frequency, because follow-up of unaffected patients was shorter than in patients with radiation necrosis. The necrotic reactions caused a transient mass effect, which lead to a significant deterioration of performance scores. Further manifestations of late delayed radiation damage were observed in two patients.

The occurrence of radiation necrosis was correlated with total radiation dose, amount of implanted radioactivity, and with velocity of tumour shrinkage. A mechanism underlying the development of radiation necrosis is proposed: A rapid shrinkage of tumour after interstitial Iodine-125 implantation may cause a significant irradiation of surrounding brain tissue, which was initially lying outside the target volume. Since most patients affected by radiation necrosis were children or adolescents, the risk of radiation damage should be minimized. This could probably be achieved either by reduction of irradiation dose, or by using temporary implants of Iodine-125.

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Authors and Affiliations

  1. Clinic of Neurosurgery, University of Heidelberg, Germany

    B. Wowra

  2. Institute of Neuropathology, University of Heidelberg, Germany

    H. P. Schmitt

  3. Department of Stereotactic Neurosurgery, University of Köln, Germany

    V. Sturm

Authors
  1. B. Wowra
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  2. H. P. Schmitt
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  3. V. Sturm
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Additional information

This study results from a cooperation between the Clinic of Neurosurgery, University of Heidelberg, FRG (Professor Dr. St. Kunze) and the Institute of Nuclear Medicine, German Cancer Research Centre, Heidelberg, FRG (Professor Dr. W. J. Lorenz). The work was supported by the Tumour Centre Heidelberg/Mannheim [Project of Neurooncology (Professor Dr. V. Sturm)].

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Wowra, B., Schmitt, H.P. & Sturm, V. Incidence of late radiation necrosis with transient mass effect after interstitial low dose rate radiotherapy for cerebral gliomas. Acta neurochir 99, 104–108 (1989). https://doi.org/10.1007/BF01402316

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