Stereotactic iodine-125 brachytherapy for treatment of inoperable focal brainstem gliomas of WHO grades I and II: feasibility and long-term outcome.

摘要: Microsurgical resection is the most frequently suggested treatment option for accessible focal brainstem gliomas (F-BSG) of World Health Organization (WHO) grades I and II. Because their location in highly eloquent brain, however, associated with permanent postoperative morbidity, ranging from 12 to 33 %. Only a few reports have stereotactic brachytherapy (SBT) implantation iodine-125 seeds as local alternative. Between 1993 2010, 47 patients were treated SBT (iodine-125 seeds; cumulative surface dose 50–65 Gy) inoperable F-BSG, WHO II, one largest reported patient series. We evaluated procedure-related complications, clinical outcome, progression-free overall survival (PFS, OS). Median follow-up was 81.6 months. Procedure-related mortality zero. Within 30 days seed six (12.8 %) had transient neurological deficits. Two (4.3 deteriorated permanently. Space-occupying cysts occurred after median 28.5 months, required surgical intervention. Nine (19.1 presented tumor relapse 56.6 months (range 7.9–118.0 months). For remaining 38 complete response observed 23.4 %, partial 29.8 stable disease 27.7 Actuarial PFS 97.7 ± 2.2, 92.8 4.0, 81.2 6.5, 62.0 10.4 % 1, 2, 5, 10 years, respectively. Corresponding OS 100 0.0 (1 2 years), 97.4 2.6 (5 87.6 7.0 (10 years). comparatively safe, minimally invasive, effective F-BSG II; it merits further evaluation prospective randomized trials.