Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas
| Autor: | Andrew S. Little, Theresa Thomas, Andrew G. Shetter, Peter Nakaji, David Brachman, Kris A. Smith, Christopher Dardis, Stephen Sorensen, Heyoung McBride, Nader Sanai, Robert F. Spetzler, Joseph M. Zabramski, Emad Youssef |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Radiography medicine.medical_treatment Brachytherapy Biocompatible Materials Meningioma Meningeal Neoplasms medicine Humans Prospective Studies Prospective cohort study Survival rate Aged business.industry Proportional hazards model General Medicine Middle Aged medicine.disease Survival Rate Treatment Outcome Cesium Radioisotopes Tumor progression Female Collagen Implant Neoplasm Recurrence Local business Nuclear medicine Follow-Up Studies |
| Zdroj: | Journal of Neurosurgery. 131:1819-1828 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2018.7.jns18656 |
| Popis: | OBJECTIVEEffective treatments for recurrent, previously irradiated intracranial meningiomas are limited, and resection alone is not usually curative. Thus, the authors studied the combination of maximum safe resection and adjuvant radiation using permanent intracranial brachytherapy (R+BT) in patients with recurrent, previously irradiated aggressive meningiomas.METHODSPatients with recurrent, previously irradiated meningiomas were treated between June 2013 and October 2016 in a prospective single-arm trial of R+BT. Cesium-131 (Cs-131) radiation sources were embedded in modular collagen carriers positioned in the operative bed on completion of resection. The Cox proportional hazards model with this treatment as a predictive term was used to model its effect on time to local tumor progression.RESULTSNineteen patients (median age 64.5 years, range 50–78 years) with 20 recurrent, previously irradiated tumors were treated. The WHO grade at R+BT was I in 4 (20%), II in 14 (70%), and III in 2 (10%) cases. The median number of prior same-site radiation courses and same-site surgeries were 1 (range 1–3) and 2 (range 1–4), respectively; the median preoperative tumor volume was 11.3 cm3 (range 0.9–92.0 cm3). The median radiation dose from BT was 63 Gy (range 54–80 Gy). At a median radiographic follow-up of 15.4 months (range 0.03–47.5 months), local failure (within 1.5 cm of the implant bed) occurred in 2 cases (10%). The median treatment-site time to progression after R+BT has not been reached; that after the most recent prior therapy was 18.3 months (range 3.9–321.9 months; HR 0.17, p = 0.02, log-rank test). The median overall survival after R+BT was 26 months, with 9 patient deaths (47% of patients). Treatment was well tolerated; 2 patients required surgery for complications, and 2 experienced radiation necrosis, which was managed medically.CONCLUSIONSR+BT utilizing Cs-131 sources in modular carriers represents a potentially safe and effective treatment option for recurrent, previously irradiated aggressive meningiomas. |
| Databáze: | OpenAIRE |
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