Effect of neoadjuvant iodine-125 brachytherapy upon resection of glioma.

BACKGROUND: A more extensive surgical resection of glioma contributes to improved overall survival (OS) and progression-free survival (PFS). However, some patients miss the chance of surgical resection when the tumor involves critical structures. PURPOSE: The present study aimed to assess the feasibility of neoadjuvant 125I brachytherapy followed by total gross resection for initially inoperable glioma. METHODS: Six patients diagnosed with inoperable glioma due to invasion of eloquent areas, bihemispheric diffusion, or large tumor volume received 125I brachytherapy. Surgical resection was performed when the tumor shrank, allowing a safe resection, assessed by the neurosurgeons. Patients were followed up after surgery. RESULTS: Shrinkage of the tumor after adjuvant 125I brachytherapy enabled a total gross resection of all six patients. Four patients were still alive at the last follow-up, with the longest survival time of more than 50 months, two of which returned to everyday life with a KPS of 100. Another two patients had neurological injuries with KPSs of 80 and 50, respectively. One patient with grade II glioma died 34 months, and another with grade IV glioma died 40 months after the combined therapy. CONCLUSIONS: In the present study, the results demonstrated that 125I brachytherapy enabled a complete resection of patients with initially unresectable gliomas. 125I brachytherapy may offer a proper neoadjuvant therapy method for glioma.

Permanent iodine-125 brachytherapy for patients with progressive or recurrent high-grade gliomas.

BACKGROUND: The prognosis of patients with progressive or recurrent high-grade gliomas (HGGs) after surgery remains poor. Iodine-125 brachytherapy is emerging as a salvage method for the treatment of gliomas. This study aimed to investigate whether permanent iodine-125 brachytherapy could be used as an effective therapeutic method even without radiotherapy and/or chemotherapy for progressive or recurrent HGG after gross total resection. METHODS: Between March 2004 and August 2016, 58 patients with progressive or recurrent HGG after gross total resection were included in this study. Twenty-nine patients underwent radiotherapy and/or chemotherapy and then permanent iodine-125 brachytherapy (SRCI group). Twenty-nine patients underwent permanent iodine-125 brachytherapy alone (SI group). Follow-up was carried out at 1, 3, and 6 months and then at 1, 2, 3, and 5 years after iodine-125 implantation. The median overall survival (OS) and progression-free survival (PFS), procedure-related complications and clinical outcomes were evaluated. RESULTS: No procedure-related fatal events happened. The temporary morbidity rate was 11.9%. The median OS and PFS for patients in the SI group were 22 and 8 months compared with 21 and 7 months in the SRCI group. No significant differences were found. Age and Karnofsky Performance Status (KPS) were independent prognostic factors for OS. Age, KPS and histology were independent prognostic factors for PFS. CONCLUSIONS: Permanent iodine-125 brachytherapy could be used as an effective therapeutic method even without radiotherapy and/or chemotherapy for progressive or recurrent HGG after gross total resection.

Dosimetry verification of 3D-printed individual template based on CT-MRI fusion for radioactive 125I seed implantation in recurrent high-grade gliomas.

PURPOSE: To verify the accuracy and efficacy of three-dimensional printing individual template (3D-PIT) with computed tomography-magnetic resonance imaging (CT-MRI) fusion for radioactive iodine-125 (125I) seed implantation in high-grade brain gliomas. MATERIAL AND METHODS: Between June 2017 and June 2018, 16 patients with recurrent high-grade gliomas (rHGG) underwent radioactive seed implantation with 3D-PIT. The prescribed dose was 120-140 Gy. We compared the dose distribution of the postoperative plan with the preoperative plan. Dose parameters included D90, V100, V200, conformity index (CI), and external index of the target volume (EI). Local control and early complications were also analyzed. RESULTS: Sixteen treatment areas were reported in our study. Median gross tumor volume (preoperative) of patients was 64.2 cm3, median needle number was 8, and median number of implanted 125I seeds was 60. For postoperative plans, the median D90, V100, and V200 was 152.1 Gy, 96.8%, and 49.1%, respectively, and 151.7 Gy, 97.0%, and 48.9%, respectively, in preoperative plans. Comparing with the preplanned cases, the dose of the target volume was slightly higher; the high-dose area of the target volume was larger in postoperative cases, but the difference was not statistically significant (p > 0.05). Actual dose conformity of the target volume was greater than preplanned, and the difference was not statistically significant (p > 0.05). Local control was 81.25% and 75% at 3 and 6 months after implantation, respectively. No serious early toxicities were observed. CONCLUSIONS: 3D-PIT based on the CT-MRI fusion images can result in good accuracy for positioning and dose distribution in radioactive seed implantation for treatment of rHGG.