PURPOSE: Resection is generally considered the gold standard for treatment of low-grade (WHO grades I and II) gliomas (LGGs) in childhood. However, approximately 30% to 50% of these tumors are inoperable because of their localization in highly eloquent brain areas. A few reports have suggested stereotactic brachytherapy (SBT) with implantation of iodine-125 ((125)I) seeds as a safe and effective local treatment alternative. This single-center study provides a summary of the long-term outcome after SBT in one of the largest reported patient series. PATIENTS AND METHODS: All pediatric patients treated with SBT ((125)I seeds; cumulative therapeutic dose 50-65 Gy within 9 months) by our group for LGG with follow-up of more than 6 months were included. Clinical and radiologic outcome, time to progression, and overall survival were evaluated. Prognostic factors (age, sex, Karnofsky performance score, tumor volume, and histology) for survival and disease progression were investigated. RESULTS: In all, 147 of 160 pediatric patients treated with SBT (from 1982 through 2009) were analyzed in detail. Procedure-related mortality was zero, and the 30-day morbidity was transient and low (5.4%). Survival rates at 5 and 10 years were 93%, and 82%, respectively, with no significant difference between WHO grades I and II tumors (median follow-up, 67.1 ± 57.7 months). Twenty-one (14.8%) of 147 patients presented with tumor relapse. The remaining 126 patients revealed complete response in 24.6%, partial response in 31.0%, and stable disease in 29.6%. Neurologic status improved (57.8%) or remained stable (23.0%). None of the evaluated factors had significant impact on the study's end points except tumor volume more than 15 mL, which caused significantly higher rates of tumor recurrence (P < .05). CONCLUSION: We demonstrate that SBT represents a safe, minimally invasive, and highly effective local treatment option for pediatric patients with inoperable LGG WHO grades I and II.
PURPOSE: Resection is generally considered the gold standard for treatment of low-grade (WHO grades I and II) gliomas (LGGs) in childhood. However, approximately 30% to 50% of these tumors are inoperable because of their localization in highly eloquent brain areas. A few reports have suggested stereotactic brachytherapy (SBT) with implantation of iodine-125 ((125)I) seeds as a safe and effective local treatment alternative. This single-center study provides a summary of the long-term outcome after SBT in one of the largest reported patient series. PATIENTS AND METHODS: All pediatric patients treated with SBT ((125)I seeds; cumulative therapeutic dose 50-65 Gy within 9 months) by our group for LGG with follow-up of more than 6 months were included. Clinical and radiologic outcome, time to progression, and overall survival were evaluated. Prognostic factors (age, sex, Karnofsky performance score, tumor volume, and histology) for survival and disease progression were investigated. RESULTS: In all, 147 of 160 pediatric patients treated with SBT (from 1982 through 2009) were analyzed in detail. Procedure-related mortality was zero, and the 30-day morbidity was transient and low (5.4%). Survival rates at 5 and 10 years were 93%, and 82%, respectively, with no significant difference between WHO grades I and II tumors (median follow-up, 67.1 ± 57.7 months). Twenty-one (14.8%) of 147 patients presented with tumor relapse. The remaining 126 patients revealed complete response in 24.6%, partial response in 31.0%, and stable disease in 29.6%. Neurologic status improved (57.8%) or remained stable (23.0%). None of the evaluated factors had significant impact on the study's end points except tumor volume more than 15 mL, which caused significantly higher rates of tumor recurrence (P < .05). CONCLUSION: We demonstrate that SBT represents a safe, minimally invasive, and highly effective local treatment option for pediatric patients with inoperable LGG WHO grades I and II.
Authors: Philipp Kickingereder; Christina Hamisch; Bogdana Suchorska; Norbert Galldiks; Veerle Visser-Vandewalle; Roland Goldbrunner; Martin Kocher; Harald Treuer; Juergen Voges; Maximilian I Ruge Journal: J Neurooncol Date: 2014-08-24 Impact factor: 4.130
Authors: K Müller; A Gnekow; F Falkenstein; J Scheiderbauer; I Zwiener; T Pietsch; M Warmuth-Metz; J Voges; G Nikkhah; M Flentje; S E Combs; D Vordermark; M Kocher; R-D Kortmann Journal: Strahlenther Onkol Date: 2013-07-07 Impact factor: 3.621
Authors: Roland Goldbrunner; Maximilian Ruge; Martin Kocher; Carolin Weiss Lucas; Norbert Galldiks; Stefan Grau Journal: Dtsch Arztebl Int Date: 2018-05-21 Impact factor: 5.594
Authors: Maximilian I Ruge; Philipp Kickingereder; Stefan Grau; Franziska Dorn; Norbert Galldiks; Harald Treuer; Volker Sturm Journal: Neuro Oncol Date: 2013-09-17 Impact factor: 12.300
Authors: Faycal El Majdoub; Clemens Neudorfer; Tobias Blau; Martin Hellmich; Christian Bührle; Martina Deckert; Volker Sturm; Mohammad Maarouf Journal: Strahlenther Onkol Date: 2015-08-26 Impact factor: 3.621
Authors: B Suchorska; C Hamisch; H Treuer; K Mahnkopf; R E Lehrke; M Kocher; M I Ruge; J Voges Journal: J Neurooncol Date: 2016-07-15 Impact factor: 4.130