Cesium-131 Interstitial Brachytherapy for Recurrent Malignancies of Skull Base

Abstract

Background Recurrent malignancy of the skull base poses a treatment challenge due to a lack of treatment options and potential for damage to surrounding structures. Methods Case report of two patients with recurrent nasopharyngeal carcinoma (NPC) of skull base previously treated with adjuvant chemoradiotherapy using intensity-modulated radiation therapy (IMRT). Results In both cases, the recurrent tumor was treated with endoscopic surgical resection and intraoperative cesium-131 (Cs-131) interstitial brachytherapy (IBT). Total dose delivered to tumor bed was 57 and 60 Gy, respectively. With a half- life of 9 days, the majority of the radiation dose had been delivered within the first 40 days following implant and there have been no treatment-related complications reported. Conclusion Intraoperative Cs-131 IBT is a feasible adjuvant treatment option for patients with recurrent malignancies of the skull base. These are the first known cases of Cs-131 IBT used for recurrent NPC.

Adjuvant Cesium‐131 Brachytherapy for Patients Intolerant of External Beam Radiation Therapy

“…1 If two different planes of seeds are required to contour the surgical defect, then they do not collapse on each other upon closure, which prevents radiation hot spots. 4 Once the 1 x 1 cm grid of seeds are established, the mesh or individual strands are secured with sutures or clips to the surrounding fascia (Supporting Video 1). Final dosing was determined based on postoperative CT scans.…”

Free tissue transfer for skull base reconstruction - a review

“…In midfacial and periorbital bony reconstruction using parascapular system free flaps (SFF), VSP was associated with more complex bony reconstructions, as well as higher accuracy as measured by the percentage of physical contact between the free flap bone segments. While VSP has not definitely been shown to decrease surgical complications, it allows reconstructive surgeons to perform more complex surgeries with shorter operative and ischemia times [11] . VSP can also be used in the setting of secondary revision of prior reconstruction, where the mirror image capabilities allow the overlay of bony projections from the normal side onto the reconstructed side.…”

Permanent Interstitial Cesium-131 Brachytherapy in Treating High-Risk Recurrent Head and Neck Cancer: A Prospective Pilot Study

“…The use of Cesium-131 (Cs-131) implants is shown to be feasible in the postoperative setting for recurrent HNC in several small series ( 8 , 9 ). The relative dosimetric properties of Cs-131 compared to iridium-192 or Iodine-125 isotopes, which include a lower mean energy and short half-life at 9.7 days, have made it an excellent candidate for treatment not only in recurrent HNC, but in the treatment of recurrent brain tumors, inoperable non-small cell lung cancer, and recurrent pelvic malignancies ( 10 – 13 ). Due to the favorable properties of both brachytherapy and Cs-131, we sought to explore the feasibility of Cs-131 implants in recurrent HNC after surgery at our institution.…”