[125-I brachytherapy of pineal parenchymal tumours in two patients and review of the literature]. / Két pinealoblastomás beteg 125-jód-brachytherapiája során nyert tapasztalatok es irodalmi áttekintés.

INTRODUCTION: Pineal parenchymal tumours make up 0.3% of all brain tumours. Stereotactic biopsy has by now become an indispensable method to detect these tumours and it can be safely performed. PATIENTS AND METHOD: Two patients with pineoblastoma were treated with 125I brachytherapy. The MRI and CT images taken 15 and 18 months after irradiation showed significant tumour shrinkage. RESULTS: Tumour volume was 0.76 cm3 in the control CT image in Case 1, a shrinkage by 73% compared to 2.87 cm3 measured at the time of planning the interstitial irradiation. In Case 2, tumour volume measured on the control MRI examination was 0.29 cm3 as opposed to 1.27 cm3 of original tumour volume, which represents a 77% shrinkage. CONCLUSION: The insertion of isotope seeds was performed at the same time as the biopsy, because thus the knowledge of the histological diagnosis could spare the patients from a second stereotactic intervention. The CT- and image fusion guided 125I stereotactic brachytherapy is a procedure that can be dosimetrically precisely planned and surgically accurately and safely performed.

[Interstitial boost and altered fractionation as novel approaches to dose escalation in the radiotherapy of glioblastoma multiforme]. / A szövetközi boost besugárzás és az eltéró frakcionálás, mint új dóziseszkalációs lehetóségek a glioblastoma multiforme sugárkezelésében.

INTRODUCTION: The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques give the opportunity to elaborate optimal treatment forms for primary brain tumours. PURPOSE: The authors examined the effect of two novel dose escalation methods on glioblastoma patients. METHODS: In nine cases they treated T1 tumours with single HDR-AL boost of 10-12 Gy dose following the conventional fractionated 60 Gy external beam radiotherapy. In fifteen patients with T2-4 tumours an intensified, hypofractionated regimen with 2.25-2.5 Gy daily and 60 Gy total dose was applied. All the treatments were carried out with image-based conformal methods. RESULTS: Majority of patients endured treatments without neurological deterioration. Transient neurotoxiticy was noticed in one and two cases, respectively. The median survival times (MST) were found to be 17 months (range: 9-25) and 12 months (range: 6-38) in the two groups, respectively. With respect to all patients, the MST was 13 months, while this value in the conventional treatment is generally considered to be 9-10 months. All the three patients who survived more than 18 months was treated with temozolamide chemotherapy as well. CONCLUSION: Based on own experience and current knowledge of authors, it seems reasonable to apply higher biological dose focal radiotherapy and chemotherapy in case of glioblastoma patients with better prognosis. To define the optimal treatment regimens randomised clinical trials should be executed.

[Image-fusion-guided radioisotope I-125 stereotactic brachytherapy of acoustic neurinoma--new surgical method]. / Akusztikus neurinoma kezelése képfúzió-vezérelt szövetközi 125-jód-izotóp-besugárzással--új mútéti eljárás.

Gamma knife and multi leaf collimator Linac have recently gained significant space in the treatment of acoustic neurinomas. As our neurosurgical department does not own gamma knife or Linac, we have successfully pursued the 125Iodine interstitial irradiation of three acoustic neurinomas. Our patients were elderly people with poor general condition, therefore we decided to undertake interstitial irradiation because of the low tolerance for surgery. The follow-up period until March 2002, lasted five, 23 and 40 months in the three cases. At the end of the follow-up period the audiometrical examination stated slight enhancement of hearing in case one and case two. In case one, the tumor volume, as measured on the control MRI was 5.32 cm3, which meant a 21% shrinkage in contrast to the 6.74 cm3 target volume at the brachytherapy. In case two, the shrinkage was even more apparent. The tumor volume measured on the control MRI examination was 6.64 cm3, which was a 42% shrinkage of the 11.45 cm3 target volume at the moment of brachytherapy. Due to financial reasons, gamma knife and Linac are not available for many countries and neurosurgical institutes. In the absence of the above mentioned radiosurgical methods, we have shown brachytherapy as a new alternative and solution in the treatment of acoustic neurinoma in three patients.

[Spinal stabilizations in our department (1989-2002)]. / Gerincstabilizációs mútétek osztályunkon 1989-2002.

With the aim to compare results to those found in the literature, authors present a retrospective overview of the spinal stabilizations carried out in the Neurosurgical Department at the St. John's Hospital, Budapest, Hungary between 1989 and 2002. This 37 bed department provides neurosurgical services to the Buda region with its one million inhabitants. Out of 156,000 injuries in total in the past 13 years, the department has dealt with 9360 neurotraumatologic cases, 560 of them suffering from spinal injuries. In parallel, non-traumatic cases were also treated for tumour, infections, degenerative diseases and for the instability of the spine. The 224 stabilised cases were classified into three groups: cervical, thoracic, lumbar. The authors enumerate the type of operation in each level and they present the number of cases belonging to each type. Septic complications occurred in 2.5% of cases. Screw breaking or slackening of the implanted devices was observed in 2% of the cases. The types of spinal operations applied provide satisfactory method for controlling the problems caused by the instability the spinal trauma, degenerative and tumourous cases. These results do not diverge from those found in the literature.