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Stereotactic brachytherapy using iodine 125 seeds for the treatment of primary and recurrent anaplastic glioma WHO° III

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Abstract

The current study analyzed the outcome after stereotactic brachytherapy (SBT) using iodine-125 seeds in anaplastic astrocytoma, oligoastrocytoma or oligodendroglioma not suitable for resection. Out of 223 patients harbouring a malignant glioma treated according to a prospective protocol, 172 patients were selected who received SBT to treat a WHO grade III de-novo/residual tumor (n = 99) or a tumor recurrence after multimodal treatment (n = 73). We assessed progression free survival (PFS), overall survival (OS), radiological and clinical outcome and determined prognostic factors using univariate and multivariate regression analyses. The median follow-up time was 38 months. Median OS and median PFS was 28.9 and 21.4 months in the de-novo group vs. 49.4 and 32.6 months in the recurrence group. Recurrent tumors had more frequently (p = 0.01) an oligodendroglial-component compared to de novo tumors. According to cohort-specific univariate analyses KPS at SBT had a significant (p = 0.008) impact on OS in the de-novo group. In the recurrence group, (Cox regression analysis) OS was significantly associated with histology subtype (oligoastro-/oligodendroglioma vs. astrocytoma, p = 0.043). Transient and permanent morbidity (~1 %) was low. For patients unable to undergo surgery due to eloquent tumour location or reduced general condition SBT is an effective treatment option, which does not foreclose additional therapeutic interventions.

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References

  1. Weller M, van den Bent M, Hopkins K, Tonn JC, Stupp R, Falini A, Cohen-Jonathan-Moyal E, Frappaz D, Henriksson R, Balana C, Chinot O, Ram Z, Reifenberger G, Soffietti R, Wick W, European Association for Neuro-Oncology Task Force on Malignant G (2014) EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 15: e395–403 doi:10.1016/S1470-2045(14)70011-7

    Article  PubMed  Google Scholar 

  2. Kickingereder P, Hamisch C, Suchorska B, Galldiks N, Visser-Vandewalle V, Goldbrunner R, Kocher M, Treuer H, Voges J, Ruge MI (2014) Low-dose rate stereotactic iodine-125 brachytherapy for the treatment of inoperable primary and recurrent glioblastoma: single-center experience with 201 cases. J Neurooncol 120:615–623. doi:10.1007/s11060-014-1595-y

    Article  CAS  PubMed  Google Scholar 

  3. Ruge MI, Kickingereder P, Grau S, Dorn F, Galldiks N, Treuer H, Sturm V (2013) Stereotactic iodine-125 brachytherapy for the treatment of WHO grades II and III gliomas located in the central sulcus region. Neuro-oncol 15:1721–1731. doi:10.1093/neuonc/not126

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Suchorska B, Ruge M, Treuer H, Sturm V, Voges J (2011) Stereotactic brachytherapy of low-grade cerebral glioma after tumor resection. Neuro-Oncol 13:1133–1142. doi:10.1093/neuonc/nor100

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schwarz SB, Thon N, Nikolajek K, Niyazi M, Tonn JC, Belka C, Kreth FW (2012) Iodine-125 brachytherapy for brain tumours–a review. Radiat Oncol 7:30. doi:10.1186/1748-717X-7-30

    Article  PubMed  PubMed Central  Google Scholar 

  6. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    CAS  PubMed  Google Scholar 

  7. 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 58:108–111

    CAS  PubMed  Google Scholar 

  8. Ruge MI, Simon T, Suchorska B, Lehrke R, Hamisch C, Koerber F, Maarouf M, Treuer H, Berthold F, Sturm V, Voges J (2011) Stereotactic brachytherapy with iodine-125 seeds for the treatment of inoperable low-grade gliomas in children: long-term outcome. J Clin Oncol 29:4151–4159. doi:10.1200/JCO.2011.37.3381

    Article  PubMed  Google Scholar 

  9. Nuno M, Birch K, Mukherjee D, Sarmiento JM, Black KL, Patil CG (2013) Survival and prognostic factors of anaplastic gliomas. Neurosurgery 73:458–465. doi:10.1227/01.neu.0000431477.02408.5e (quiz 465)

    Article  PubMed  Google Scholar 

  10. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, Norrell HA, Owens G, Ransohoff J, Wilson CB, Gehan EA, Strike TA (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333–343. doi:10.3171/jns.1978.49.3.0333

    Article  CAS  PubMed  Google Scholar 

  11. Laperriere N, Zuraw L, Cairncross G, Cancer care ontario practice guidelines initiative neuro-oncology disease site G (2002) Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. J Eur Soc Ther Radiol Oncol 64:259–273

    Article  Google Scholar 

  12. Stewart LA (2002) Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. The Lancet 359:1011–1018

    Article  CAS  Google Scholar 

  13. Wick W, Hartmann C, Engel C, Stoffels M, Felsberg J, Stockhammer F, Sabel MC, Koeppen S, Ketter R, Meyermann R, Rapp M, Meisner C, Kortmann RD, Pietsch T, Wiestler OD, Ernemann U, Bamberg M, Reifenberger G, von Deimling A, Weller M (2009) NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol 27:5874–5880. doi:10.1200/JCO.2009.23.6497

    Article  CAS  PubMed  Google Scholar 

  14. Cairncross JG, Wang M, Jenkins RB, Shaw EG, Giannini C, Brachman DG, Buckner JC, Fink KL, Souhami L, Laperriere NJ, Huse JT, Mehta MP, Curran WJ Jr (2014) Benefit from procarbazine, lomustine, and vincristine in oligodendroglial tumors is associated with mutation of IDH. J Clin Oncol 32:783–790. doi:10.1200/JCO.2013.49.3726

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Krishnaswamy V (1978) Dose distribution around an 125I seed source in tissue. Radiology 126:489–491. doi:10.1148/126.2.489

    Article  CAS  PubMed  Google Scholar 

  16. Julow J, Viola A, Balint K, Szeifert GT (2007) Image fusion-guided stereotactic iodine-125 interstitial irradiation of inoperable and recurrent gliomas. Prog Neurol Surg 20:303–311. doi:10.1159/0000100174

    Article  PubMed  Google Scholar 

  17. Kreth FW, Faist M, Grau S, Ostertag CB (2006) Interstitial 125I radiosurgery of supratentorial de novo WHO Grade 2 astrocytoma and oligoastrocytoma in adults: long-term results and prognostic factors. Cancer 106:1372–1381. doi:10.1002/cncr.21750

    Article  PubMed  Google Scholar 

  18. Selker RG, Shapiro WR, Burger P, Blackwood MS, Arena VC, Gilder JC, Malkin MG, Mealey JJ Jr, Neal JH, Olson J, Robertson JT, Barnett GH, Bloomfield S, Albright R, Hochberg FH, Hiesiger E, Green S, Brain Tumor Cooperative G (2002) The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery 51:343–355 (discussion 355-347)

    PubMed  Google Scholar 

  19. Laperriere NJ, Leung PM, McKenzie S, Milosevic M, Wong S, Glen 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

    Article  CAS  PubMed  Google Scholar 

  20. Scharfen CO, Sneed PK, Wara WM, Larson DA, Phillips TL, Prados MD, Weaver KA, Malec M, Acord P, Lamborn KR et al (1992) High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys 24:583–591

    Article  CAS  PubMed  Google Scholar 

  21. Gutin PH, Prados MD, Phillips TL, Wara WM, Larson DA, Leibel SA, Sneed PK, Levin VA, Weaver KA, Silver P et al (1991) External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82-2. Int J Radiat Oncol Biol Phys 21:601–606

    Article  CAS  PubMed  Google Scholar 

  22. Bernstein M, Laperriere N, Leung P, McKenzie S (1990) Interstitial brachytherapy for malignant brain tumors: preliminary results. Neurosurgery 26:371–379 (discussion 379-380)

    Article  CAS  PubMed  Google Scholar 

  23. Ostertag CB, Kreth FW (1992) Iodine-125 interstitial irradiation for cerebral gliomas. Acta Neurochir (Wien) 119:53–61

    Article  CAS  Google Scholar 

  24. Zamorano L, Li Q, Tekyi-Mensah S, Gaspar L, Fontanesi J, Levin K (2003) Permanent iodine-125 interstitial radiation therapy in the treatment of non-glioblastoma multiforme high-grade gliomas. Stereotact Funct Neurosurg 81:10–17

    Article  PubMed  Google Scholar 

  25. Kumar PP, Good RR, Jones EO, Patil AA, Leibrock LG, McComb RD (1989) Survival of patients with glioblastoma multiforme treated by intraoperative high-activity cobalt 60 endocurietherapy. Cancer 64:1409–1413

    Article  CAS  PubMed  Google Scholar 

  26. Prados MD, Gutin PH, Phillips TL, Wara WM, Sneed PK, Larson DA, Lamb SA, Ham B, Malec MK, Wilson CB (1992) Interstitial brachytherapy for newly diagnosed patients with malignant gliomas: the UCSF experience. Int J Radiat Oncol Biol Phys 24:593–597

    Article  CAS  PubMed  Google Scholar 

  27. Hitchon PW, VanGilder JC, Wen BC, Jani S (1992) Brachytherapy for malignant recurrent and untreated gliomas. Stereotact Funct Neurosurg 59:174–178

    Article  CAS  PubMed  Google Scholar 

  28. Intergroup Radiation Therapy Oncology Group T, Cairncross G, Berkey B, Shaw E, Jenkins R, Scheithauer B, Brachman D, Buckner J, Fink K, Souhami L, Laperierre N, Mehta M, Curran W (2006) Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: intergroup Radiation Therapy Oncology Group trial 9402. J Clin Oncol 24:2707–2714. doi:10.1200/JCO.2005.04.3414

    Article  Google Scholar 

  29. Eckel-Passow JE, Igel DA, Serie DJ, Joseph RW, Ho TH, Cheville JC, Parker AS (2015) Assessing the clinical use of clear cell renal cell carcinoma molecular subtypes identified by RNA expression analysis. Urol Oncol 33(68):e17–e23. doi:10.1016/j.urolonc.2014.07.019

    PubMed  Google Scholar 

  30. Leibel SA, Gutin PH, Wara WM, Silver PS, Larson DA, Edwards MS, Lamb SA, Ham B, Weaver KA, Barnett C et al (1989) Survival and quality of life after interstitial implantation of removable high-activity iodine-125 sources for the treatment of patients with recurrent malignant gliomas. Int J Radiat Oncol Biol Phys 17:1129–1139

    Article  CAS  PubMed  Google Scholar 

  31. Gaspar LE, Zamorano LJ, Shamsa F, Fontanesi J, Ezzell GE, Yakar DA (1999) Permanent 125iodine implants for recurrent malignant gliomas. Int J Radiat Oncol Biol Phys 43:977–982

    Article  CAS  PubMed  Google Scholar 

  32. Kong DS, Lee JI, Park K, Kim JH, Lim DH, Nam DH (2008) Efficacy of stereotactic radiosurgery as a salvage treatment for recurrent malignant gliomas. Cancer 112:2046–2051. doi:10.1002/cncr.23402

    Article  PubMed  Google Scholar 

  33. Hall WA, Djalilian HR, Sperduto PW, Cho KH, Gerbi BJ, Gibbons JP, Rohr M, Clark HB (1995) Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol 13:1642–1648

    CAS  PubMed  Google Scholar 

  34. Kondziolka D, Flickinger JC, Bissonette DJ, Bozik M, Lunsford LD (1997) Survival benefit of stereotactic radiosurgery for patients with malignant glial neoplasms. Neurosurgery 41:776–783 (discussion 783-775)

    Article  CAS  PubMed  Google Scholar 

  35. Vick NA, Ciric IS, Eller TW, Cozzens JW, Walsh A (1989) Reoperation for malignant astrocytoma. Neurology 39:430–432

    Article  CAS  PubMed  Google Scholar 

  36. Azizi A, Black P, Miyamoto C, Croul SE (2001) Treatment of malignant astrocytomas with repetitive resections: a longitudinal study. Isr Med Assoc J 3:254–257

    CAS  PubMed  Google Scholar 

  37. Sipos L, Afra D (1997) Re-operations of supratentorial anaplastic astrocytomas. Acta Neurochir (Wien) 139:99–104

    Article  CAS  Google Scholar 

  38. Schwartz C, Romagna A, Thon N, Niyazi M, Watson J, Belka C, Tonn JC, Kreth FW, Nachbichler SB (2015) Outcome and toxicity profile of salvage low-dose-rate iodine-125 stereotactic brachytherapy in recurrent high-grade gliomas. Acta Neurochir (Wien) 157:1757–1764. doi:10.1007/s00701-015-2550-1

    Article  Google Scholar 

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Acknowledgments

We would like to thank Volker Sturm for establishing the prospective treatment protocol and for treating numerous patients during his Chairmanship at the Department of Stereotaxy and Functional Neurosurgery from 1990 to 2012.

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Author notes

  1. B. Suchorska

    Present address: Department of Neurosurgery, Ludwig Maximilians University of Munich, Munich, Germany

Authors and Affiliations

  1. Department of Stereotactic Neurosurgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany

    B. Suchorska, K. Mahnkopf & J. Voges

  2. Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, University of Cologne, Cologne, Germany

    C. Hamisch, H. Treuer & M. I. Ruge

  3. Department of Neurosurgery, Centre of Neurosurgery, University of Cologne, Cologne, Germany

    C. Hamisch

  4. Department of Stereotactic Neurosurgery, St. Barbara Hospital, Hamm, Germany

    R. E. Lehrke

  5. Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany

    M. Kocher

  6. Leibniz Institute for Neurobiology, Magdeburg, Germany

    J. Voges

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Suchorska, B., Hamisch, C., Treuer, H. et al. Stereotactic brachytherapy using iodine 125 seeds for the treatment of primary and recurrent anaplastic glioma WHO° III. J Neurooncol 130, 123–131 (2016). https://doi.org/10.1007/s11060-016-2214-x

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