Stereotactic biopsy combined with stereotactic 125iodine brachytherapy for diagnosis and treatment of locally recurrent single brain metastases

Abstract

This paper reports on stereotactic biopsy combined with stereotactic (125)iodine brachytherapy (SBT) for locally recurrent, previously irradiated cerebral metastases, focusing on feasibility, complications, cerebral disease control, and survival. All patients with suspected locally recurrent metastases detected by MRI were selected for this combined procedure. After stereotactic biopsy, all patients with a verified vital tumor underwent SBT (50 Gy surface dose applied for 42 days) during the same surgical procedure. Histological results of biopsy, complications, treatment response, local and distant disease control, and survival were evaluated. Thirty patients underwent stereotactic biopsy, and 27 were treated with SBT for histologically proved tumor recurrence. There was no treatment-related mortality, and morbidity was transient and low (6.6%). Median survival was 14.8 months. After one year the actuarial incidence of local and distant relapse was 6.7 and 45.5%, respectively. There was no grade 3 or 4 CNS toxicity, even among the 18.5% of patients with tumors >30 mm. For these patients stereotactic biopsy seems to be a safe and valuable means of differentiating between radiation-induced tissue changes and tumor recurrence/progression. SBT is a safe, minimally invasive, and highly effective treatment option for cerebral disease control and survival. Furthermore, it can be performed during the same stereotactic operation.

Iodine-125 brachytherapy for brain tumours - a review

“…All in all, iodine-125 brachytherapy for metastases has become more popular again in recent years due to its radiobiological advantages and as it can be employed even after extensive percutaneous pre-irradiation [120], additionally biopsies are possible in the same session [154,163]. …”

Differentiation of local tumor recurrence from radiation-induced changes after stereotactic radiosurgery for treatment of brain metastasis: case report and review of the literature

“…We therefore decided to perform a stereotactic biopsy for histological evaluation of the suspicious left frontal lesion. According to our previously reported protocol, a stereotactic 125 I brachytherapy (SBT) after intraoperative verification of tumor within the same surgical procedure was planned [6,14]. Intraoperatively, histological findings were consistent with radiation necrosis (Figure 4).…”

Multidisciplinary Care of Patients with Brain Tumors

“…16 The primary rationale for brachytherapy is that it can deliver highly localized radiation over the effective life of the radioisotope to a well-defined target, thereby preserving the surrounding normal tissue from dose. Brachytherapy applications in the brain are generally limited to cases of recurrent tumors, 17,18 although different applications are actively being explored. 17 …”

“…Brachytherapy applications in the brain are generally limited to cases of recurrent tumors, 17,18 although different applications are actively being explored. 17 …”