Abstract
Owing to its low rate of side effects and its high efficacy, interstitial irradiation with low-activity seeds should be the first therapeutic step in small (maximal diameter 40 mm), well-circumscribed, lowgrade gliomas affecting the brain stem, other midline structures, or eloquent cerebral areas. In anaplastic gliomas, a therapeutic schedule using low-activity seeds and combining interstitial irradiation with radiotherapy (reduced boost dose of 1530 Gy) seems to be more effective than interstitial irradiation alone. Compared with interstitial irradiation with high-activity seeds, this combined irradiation schedule caused no space-occupying radiation necrosis. Thus, it can be recommended as up-front treatment in patients with small (maximal diameter <40 mm) inoperable anaplastic gliomas. The use of high-activity I-125 seeds and interstitial irradiation at comparably high dose rates, integrating a small penumbra of normal brain tissue into the treatment volume, improved survival significantly in patients with primary highly malignant gliomas. In patients with recurrent tumors, the same treatment schedule did not substantially prolong survival compared with results obtained after resection plus radiotherapy. Owing to the high frequency of space-occupying radiation necrosis (40-60%), this schedule is only applicable in surgically accessible tumors. The application of lowactivity I-125 seeds (in primary glioblastomas in combination with radiotherapy, in recurrent tumors without radiotherapy) yielded a median survival comparable with conventionally treated patients. There was no need for reoperation because of radiation necrosis. Thus, this treatment schedule is useful in both operable and surgically inaccessible glioblastomas.
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Papers reviewed
Kreth FW, Faist M, Warnke PC, Roliner R, Birg W, Volk B, Ostertag CB (1995) Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82:418–429
Kreth FW, Faist M, Roliner R, Birg W, Volk B, Ostertag CB (1997) The risk of interstitial radiotherapy of low-grade gliomas. Radiother Oncol 43: 253–260
Wen PY, Alexander E III, Black PM, Fine HA, Riese N, Levin JM, Coleman CN, Loefer JS (1994) Long term results of stereotactic brachytherapy used in the initial treatment of patients with glioblastomas. Cancer 73:3029–3036
Malkin MG (1992) Interstitial irradiation of malignant gliomas. Rev Neurol (Paris) 148:448–453
Scharfen CO, Sneed PK, Wara WM, Larson DA, Phillips TL, Prados MD, Weaver KA, Malec M, Acord P, Lamborn KR, Lamb SA, Ham B, Gutin PH (1992) High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys 24:583–591
Laperierre NJ, Leung PMK, McKenzie S, Milosevic M, Wong S, Glenn J, Pintilie M, Bernstein M (1998) Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys 41:1005–1011
Further reading
Bernstein M, Hoffmann HJ, Halliday WC, Hendrick EB, Humphreys RP (1984) Thalamic tumors in children. J Neurosurg 61:649–656
Bernstein M, Lumley M, Davidson G, Laperriere N, Leung P (1993) Intracranial arterial occlusion associated with high-active iodine-125 brachytherapy for glioblastoma. J Neurooncol 17:253–260
Greenwood J (1973) Radical surgery of tumors of the thalamus, hypothalamus, and third ventricle area. Surg Neurol 1:29–33
Karim ABMF, Maat B, Haltlevoll R, Menten J, Rutten EHJM, Thomas DGT, Mascarenhas F, Horiot JC, Parvinen LM, Reijn M van, Jager JJ, Fbrini MG, Alphen AM van, Hamers HP, Gaspar L, Noordman E, Pierart M, Glabbeke M van (1996) A randomized trial on dosere-sponse in radiation therapy of low-grade cerebral gliomas: European Association for Research and Treatment of Cancer (EORTC) study 22844. Int J Radiat Oncol Biol Phys 36:549–556
Kelly PJ (1989) Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery 25:185–195
Ostertag CB, Kreth FW (1992) Iodine-125 interstitial irradiation for cerebral glioma. Acta Neurochir (Wien) 119:53–61
Voges J, Treuer H, Schlegel W, Pastyr O, Sturm V (1993) Interstitial irradiation of cerebral gliomas with stereotactically implanted iodine-125 seeds. Acta Neurochir Suppl (Wien) 58:108–111
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Voges, J., Sturm, V. Interstitial irradiation with stereotactically implanted I-125 seeds for the treatment of cerebral glioma. Crit Rev Neurosurg 9, 223–233 (1999). https://doi.org/10.1007/s003290050137
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DOI: https://doi.org/10.1007/s003290050137