A matched-pair analysis of clinical outcomes after intracavitary cesium-131 brachytherapy versus stereotactic radiosurgery for resected brain metastases

Da, Julie; Sp, Lazow; Db, Vanderbilt; Taube, Shoshana; Mz, Yondorf; Sabbas, Albert; Pannullo, Susan C.; Th, Schwartz; Ag, Wernicke

doi:10.3171/2020.3.jns193419

Cited by 20 publications

(10 citation statements)

References 33 publications

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“…While the use of adjuvant WBRT eliminates concerns over precisely where to treat, this tradeoff is increasingly unpopular clinically [2,6,7]. We and other centers investigating brain brachytherapy for metastasis believe that it may be particularly useful in larger lesions as control appears relatively independent of size [20][21][22][23]; our study results support this finding. Figure 2 shows our LC by size grouping and with only one failure.…”

Section: Local Controlsupporting

confidence: 72%

“…The major difference between these isotopes is that Cs-131 has a t ½ of 9.7 days compared to 59.4 days for I-125, and this markedly shorter half-life allows a much more rapid dose delivery, diminished time of radiation exposure, and possibly more rapid tumor control [18,19]. Published studies about Cs-131 to date have used a variety of doses and implantation techniques, and outcomes appear to match or exceed what is currently achievable with EBRT approaches [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Resection and Surgically Targeted Radiation Therapy for the Treatment of Larger Recurrent or Newly Diagnosed Brain Metastasis: Results From a Prospective Trial

Nakaji

Smith

Youssef

et al. 2020

Cureus

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Introduction Achieving durable local control (LC) for larger (e.g., >2-3 cm) brain metastasis whether newly diagnosed or recurrent remains problematic. Resection (R) alone is typically insufficient and adding radiation therapy (RT) still results in a 12-month recurrence rate of 20% or more in many series. Hypothesizing that R plus immediate radiation utilizing brachytherapy may improve outcomes for this cohort of patients, we designed and prospectively evaluated a permanently implanted surgically targeted radiation therapy (STaRT) device consisting of cesium-131 (Cs-131) seeds positioned within a collagen carrier (GammaTile, GT Medical Technologies, Tempe, AZ). The device was designed to prevent direct source-to-brain contact and maintain inter-source spacing after closure. Methods This was a subgroup analysis of a cohort of patients with either recurrent or previously untreated brain metastases enrolled in a prospective, multi-histology single-arm trial (ClinicalTrials.gov, NCT#03088579), conducted between February 2013 and February 2018, of resection and tumor bed brachytherapy with Cs-131 containing permanently implanted collagen tiles to deliver 60 Gray (Gy) at .5 cm depth. No additional local therapy was given without progression. Results A total of 16 metastases in 11 patients were treated; 12 tumors were recurrent and four were previously untreated. The median preoperative maximum diameter was 3.2 cm (range: 1.9-5.1 cm). Histology was seven breasts, six lungs, and three sarcomas. The median age was 60 years (range: 41-80 years); the Karnofsky Performance Status (KPS) was 70 (range: 70-90). The cohort consisted of seven females and four males. The mean time for implantation completion was five minutes. The median overall survival (OS) was 9.3 months. At a median radiographic follow-up of 9.5 months' treatment, site progression was found in 1/16 (6%) at 10.9 months, and the median treatment site time-to-progression (TTP) has not been reached [95% confidence interval (CI): >10.9 months]. At 12 months, the Kaplan-Meier (K-M) estimates for LC after R+STaRT for all tumors was 83%; for previously untreated tumors, LC at 12 months was 100% and for recurrent tumors, it was 80%. Two tumor beds (12.5%) experienced radiation brain changes: one had grade two and the other grade three. No surgical adverse events occurred. Conclusion In this single-arm precommercial study, R+STaRT demonstrated excellent safety and LC in this cohort. The device has recently received FDA clearance for use in newly diagnosed and recurrent brain metastasis, and randomized clinical trials vs. standard of care treatments in both settings are scheduled to open in 2020.

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Section: Local Controlsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Resection and Surgically Targeted Radiation Therapy for the Treatment of Larger Recurrent or Newly Diagnosed Brain Metastasis: Results From a Prospective Trial

Nakaji

Smith

Youssef

et al. 2020

Cureus

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“… 121 In a matched pair analysis of patients treated with SRS versus cesium-131 radioisotope brachytherapy seeds after gross total resection of a brain metastasis, the local recurrence rate was significant lower in the brachytherapy seed cohort compared to SRS. 122 …”

Section: Future Directions and Unanswered Questionsmentioning

confidence: 99%

A multidisciplinary management algorithm for brain metastases

Ramos

Larsen

Pannullo

et al. 2022

Neuro-Oncology Advances

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The incidence of brain metastases continues to present a management issue despite the advent of improved systematic control and overall survival. While the management of oligometastatic disease (i.e. 1-4 brain metastases) with surgery and radiation has become fairly straightforward in the era of radiosurgery, the management of patients with multiple metastatic brain lesions can be challenging. Here we review the available evidence and provide a multidisciplinary management algorithm for brain metastases that incorporates the latest advances in surgery, radiation therapy, and systemic therapy whilst taking into account the latest in precision medicine guided therapies. In particular, we argue that whole brain radiation therapy can likely be omitted in most patients as up-front therapy.

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“…The significantly improved DRFS was not anticipated and was speculated to be due to either delays in initiating or continuing systemic treatments for SRS patients or unaccounted differences between the two cohorts. 70 Lastly, a prospective study by Pham et al suggests that 131 Cs brachytherapy may support stable or improved functional recovery as measured by FACT-Br and MMSE scores. 71 These results are favorable given that prior studies have associated radiotherapy with post-operative neurocognitive decline.…”

Section: Surgical Approachmentioning

confidence: 99%

Surgical advances in the management of brain metastases

Choi

Aghi

et al. 2021

Neuro-Oncology Advances

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As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.

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A matched-pair analysis of clinical outcomes after intracavitary cesium-131 brachytherapy versus stereotactic radiosurgery for resected brain metastases

Cited by 20 publications

References 33 publications

Resection and Surgically Targeted Radiation Therapy for the Treatment of Larger Recurrent or Newly Diagnosed Brain Metastasis: Results From a Prospective Trial

Resection and Surgically Targeted Radiation Therapy for the Treatment of Larger Recurrent or Newly Diagnosed Brain Metastasis: Results From a Prospective Trial

A multidisciplinary management algorithm for brain metastases

Surgical advances in the management of brain metastases

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