Interstitial Radiosurgery with Iodine-125 Seeds in the Treatment of Brain Metastases, Glial Tumours and Benign Intracran
In a retrospective single-centre study, we analysed data of 1,378 patients (55 % male, 45 % female) who underwent interstitial radiotherapy with 1,596 implanted Iodine-125 seeds in the Department of Stereotactic and Functional Neurosurgery in Freiburg fro
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Abstract In a retrospective single-centre study, we analysed data of 1,378 patients (55 % male, 45 % female) who underwent interstitial radiotherapy with 1,596 implanted Iodine-125 seeds in the Department of Stereotactic and Functional Neurosurgery in Freiburg from January 1990 to December 2011. The medical prerequisites and physical parameters of the treatment with Iodine-125 seeds are given. The method used in Freiburg relying on temporary Iodine-125 seed implants is described in detail and analysed. The survival rates and the peri-operative risk are evaluated. We conclude that interstitial radiosurgery with Iodine-125 seeds is a safe and useful tool, offering a wide range of treatment options for benign and also malignant intracranial lesions, especially if they are small, deep-seated, in eloquent areas, or not suitable for micro-surgery. Keywords Brachytherapy • Iridium-192 • Iodine-125 • Seeds • Interstitial radiotherapy • Stereotactic biopsy • Glioma • Low-grade glioma • Brain tumours • Metastases • Hamartoma • Child • Adults • Survival • Adverse events
M. Trippel, MD (*) and T. Reithmeier, MD Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Neurosurgical Clinic, University Medical Center Freiburg, Breisacher Straße 64, Freiburg D-79106, Germany e-mail: [email protected]
Introduction Interstitial radiosurgery (IRS) with iodine seeds, a form of brachytherapy (brachy derived from the Greek meaning “short”) is an internal radiotherapy where a radiation source is placed inside or nearby a radiosensitive lesion for treatment. Brachytherapy has a long and well-established tradition in the Department of Stereotactic and Functional Neurosurgery in Freiburg [2, 3, 5–15]. In a retrospective study, we analysed data of all the patients that underwent brachytherapy treatment with Iodine-125 Seeds in Freiburg from 1990 to 2011. In earlier years, permanent implants of Iridium-192 made from thin flexible wires (5) that could be cut to any length were implanted by a stereotactic procedure. Iridium-192 has a halflife of 73.83 days, a mean energy of 380 keV, and half value layer of ~65 mm in tissue. Iodine-125 seeds used nowadays are sized 4.5 × 0.8 mm with 59.43 days half-life, delivering much lower photon energy in the range of 27.4–35.5 keV. These seeds contain Iodine-125 adsorbed onto a radio-opaque silver rod hermetically encapsulated in a welded titanium capsule. Typically available apparent activities range from 1 to 25 mCi. Due to their favourable physical properties and high attenuation (half value layer ~17 mm) in tissue, these seeds present a sharp dose decline and are therefore well-suited for the treatment of small (10–30 mm) intracranial lesions, also nearby eloquent and radiosensitive structures. The lower photon energy and thereby high natural absorption in tissue has the additional advantage that surrounding persons get a radiation exposure far below 1 mSv, which generally can avoid shielding and isolation of patients.
G. Nikkhah, MD, PhD Division of Stere
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