Long-term outcome of stereotactic brachytherapy with temporary Iodine-125 seeds in patients with WHO grade II gliomas
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RESEARCH
Long‑term outcome of stereotactic brachytherapy with temporary Iodine‑125 seeds in patients with WHO grade II gliomas Juliana Watson1, Alexander Romagna2,3, Hendrik Ballhausen1, Maximilian Niyazi1, Stefanie Lietke4, Sebastian Siller4, Claus Belka1,5, Niklas Thon4 and Silke Birgit Nachbichler1*
Abstract Background: This long-term retrospective analysis aimed to investigate the outcome and toxicity profile of stereotactic brachytherapy (SBT) in selected low-grade gliomas WHO grade II (LGGII) in a large patient series. Methods: This analysis comprised 106 consecutive patients who received SBT with temporary Iodine-125 seeds for histologically verified LGGII at the University of Munich between March 1997 and July 2011. Investigation included clinical characteristics, technical aspects of SBT, the application of other treatments, outcome analyses including malignization rates, and prognostic factors with special focus on molecular biomarkers. Results: For the entire study population, the 5- and 10-years overall survival (OS) rates were 79% and 62%, respectively, with a median follow-up of 115.9 months. No prognostic factors could be identified. Interstitial radiotherapy was applied in 51 cases as first-line treatment with a median number of two seeds (range 1–5), and a median total implanted activity of 21.8 mCi (range 4.2–43.4). The reference dose average was 54.0 Gy. Five- and ten-years OS and progression-free survival rates after SBT were 72% and 43%, and 40% and 23%, respectively, with a median followup of 86.7 months. The procedure-related mortality rate was zero, although an overall complication rate of 16% was registered. Patients with complications had a significantly larger tumor volume (p = 0.029). Conclusion: SBT is a minimally invasive treatment modality with a favorable outcome and toxicity profile. It is both an alternative primary treatment method as well as an adjunct to open tumor resection in selected low-grade gliomas. Keywords: Stereotactic brachytherapy, Iodine-125 seeds, Grade II glioma, Low-grade glioma Background The management of low-grade gliomas WHO grade II (LGGII) is still a difficult undertaking. Several evidence-based clinical practice parameter guidelines have been formulated [1–6]. The results of the recently published EORTC 22033–26033 study further stress the
*Correspondence: [email protected]‑muenchen.de 1 Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany Full list of author information is available at the end of the article
importance of molecular analyses to individualize LGGII treatment [7]. Stereotactic brachytherapy (SBT) is a safe and effective local treatment option in selected LGGII. The steep dose gradients enable the delivery of a high dose to a defined target volume, while sparing surrounding healthy tissue [8]. Assessing the invasiveness associated with open brain surgery and the treatment-related side effects as well as the lifetime dose limits of external beam radiotherapy (
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