Outcomes of Metastatic Brain Lesions Treated with Radioactive Cs-131 Seeds after Surgery: Experience from One Institution

Abstract

IntroductionBrain metastases are common in patients with advanced systemic cancer and often recur despite treatment with surgical resection and radiotherapy. Whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) have significantly improved local control rates but are limited by complications including neurocognitive deficits and radiation necrosis. These risks can be higher in the re-irradiation setting. Brachytherapy may be an alternative method of additional targeted adjuvant radiotherapy with acceptable rates of toxicity.MethodsA retrospective chart review of all patients undergoing resection for metastatic brain lesions and permanent low-dose rate Cs-131 brachytherapy was performed for one institution over a 10-year period. All patients had previous radiation therapy already and, after surgery, were followed with imaging every three months. Patient demographics, disease characteristics, intracranial disease, peri- and post-operative complications, and outcomes were recorded. The primary outcome of interest was local tumor recurrence at the site of brachytherapy while secondary outcomes included distant disease progression (within the brain) and complications such as radiation necrosis.ResultsDuring the study period, nine cases of individual patients met inclusion criteria. The median preoperative lesion diameter was 3 cm (0.8–4.1). The median overall survival after surgery and brachytherapy was 10.3 months, after excluding two patients who were lost to follow-up. Six of nine patients had no local recurrence, while three patients had development or progression of distant lesions. No patients experienced acute or delayed complications.ConclusionCs-131 brachytherapy is a promising alternative method for controlling brain metastases after previous radiation interventions and surgical resection. In this case series, there were no incidences of local tumor recurrence or complications such as radiation necrosis.

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

“…15 Xia et al retrospectively evaluated 9 patients who had received surgery and Cs-131 brachytherapy, and did not encounter RN, with a median follow-up of 9 months. 31 Similarly, a prospective study of patients with BM managed with resection and adjuvant Cs-131 implantation reported no RN. 32 We did not observe a significant difference in rates of RR, DR, or OS between patients managed with Cs-131 and SRS.…”

Surviving Over a Decade With Glioblastoma: A Clinical Course Characterized by Multiple Recurrences, Numerous Salvage Treatments, and Novel Use of Cesium-131 Tiles

“…Overall, this leads to very conformal and localized treatment plans. Previous studies evaluated the use of these implanted Cs-131 seeds in brain metastases, meningiomas, and gliomas and showed a favorable toxicity profile [4,5,[13][14][15]. Additional benefits of this technique include immediate post-resection initiation of radiation in a rapidly proliferating tumor and the relative ease of use when applying the tiles [3].…”

Innovations in Metastatic Brain Tumor Treatment

“…Recently, a randomized trial evaluated cesium-131 for the treatment of MBTs [207]. Twentyfour patients underwent total resection followed by intraoperative placement of cesium-131 with a planned dose of 80 Gy [207,208]. The patients had no local recurrence, symptomatic radiation necrosis, and minimal surgical morbidity.…”