BACKGROUND: Treatment of spinal and intracranial tumors with dural involvement is complicated by radiation tolerance of sensitive structures, especially in the setting of previous treatment. OBJECTIVE: To evaluate whether intraoperative brachytherapy with short-range sources allows therapeutic dose delivery without damaging sensitive structures. METHODS: The median doses of previous treatment were 3000 cGy (range, 1800-7200 cGy) for 8 patients with primary/recurrent and 17 patients with metastatic spinal tumors and 5040 cGy (range, 1300-6040 cGy) for 5 patients with locally recurrent and 2 patients with metastatic intracranial tumors. Patients underwent gross total or maximal resection of the tumor and were then treated with an intraoperative brachytherapy plaque consisting of a flexible silicone film incorporating P. A dose of 1000 cGy was delivered to a depth of 1 mm; the percent depth dose was less than 1% at 4 mm from the prescription depth. Median postoperative radiation doses of 2700 cGy (range, 1800-3000 cGy) were delivered to 15 spinal tumor patients and 3000 cGy (range, 1800-3000 cGy) to 3 intracranial tumor patients. The median follow-up was 4.4 months (range, 2.6-23.3 months) for spinal tumor patients and 5.3 months (range, 0.7-16.2) for intracranial tumor patients. RESULTS: At 6-month follow-up, for all spinal tumor patients, local progression-free survival and overall survival rates were both 83.3% (95% confidence interval [CI]: 62.3%-94.3%); for all intracranial tumor patients, the local progression-free survival rate was 62.5% (95% CI: 23.8%-90.9%) and the overall survival rate was 66.7% (95% CI: 26.7%-92.9%). There were no intraoperative or postoperative complications secondary to radiotherapy. CONCLUSION: Use of the P brachytherapy plaque is technically simple and not associated with increased risk of complications, even after multiple radiation courses. Local control rates were more than 80% in patients with proven radiation-resistant spinal disease.
BACKGROUND: Treatment of spinal and intracranial tumors with dural involvement is complicated by radiation tolerance of sensitive structures, especially in the setting of previous treatment. OBJECTIVE: To evaluate whether intraoperative brachytherapy with short-range sources allows therapeutic dose delivery without damaging sensitive structures. METHODS: The median doses of previous treatment were 3000 cGy (range, 1800-7200 cGy) for 8 patients with primary/recurrent and 17 patients with metastatic spinal tumors and 5040 cGy (range, 1300-6040 cGy) for 5 patients with locally recurrent and 2 patients with metastatic intracranial tumors. Patients underwent gross total or maximal resection of the tumor and were then treated with an intraoperative brachytherapy plaque consisting of a flexible silicone film incorporating P. A dose of 1000 cGy was delivered to a depth of 1 mm; the percent depth dose was less than 1% at 4 mm from the prescription depth. Median postoperative radiation doses of 2700 cGy (range, 1800-3000 cGy) were delivered to 15 spinal tumorpatients and 3000 cGy (range, 1800-3000 cGy) to 3 intracranial tumorpatients. The median follow-up was 4.4 months (range, 2.6-23.3 months) for spinal tumorpatients and 5.3 months (range, 0.7-16.2) for intracranial tumorpatients. RESULTS: At 6-month follow-up, for all spinal tumorpatients, local progression-free survival and overall survival rates were both 83.3% (95% confidence interval [CI]: 62.3%-94.3%); for all intracranial tumorpatients, the local progression-free survival rate was 62.5% (95% CI: 23.8%-90.9%) and the overall survival rate was 66.7% (95% CI: 26.7%-92.9%). There were no intraoperative or postoperative complications secondary to radiotherapy. CONCLUSION: Use of the P brachytherapy plaque is technically simple and not associated with increased risk of complications, even after multiple radiation courses. Local control rates were more than 80% in patients with proven radiation-resistant spinal disease.
Authors: Ori Barzilai; Ilya Laufer; Adam Robin; Ran Xu; Yoshiya Yamada; Mark H Bilsky Journal: Oper Neurosurg (Hagerstown) Date: 2019-03-01 Impact factor: 2.703
Authors: Patrick D Kelly; Scott L Zuckerman; Yoshiya Yamada; Eric Lis; Mark H Bilsky; Ilya Laufer; Ori Barzilai Journal: Neurosurg Rev Date: 2019-06-01 Impact factor: 3.042
Authors: Brian P Marr; David H Abramson; Gil'ad N Cohen; Matthew J Williamson; Beryl McCormick; Christopher A Barker Journal: JAMA Ophthalmol Date: 2015-03 Impact factor: 7.389
Authors: Liana Mulet; Izabella Barreto; Gil'ad N Cohen; Antonio L Damato; Thomas Mauceri; Jennifer Pursley; Christopher L Deufel Journal: Brachytherapy Date: 2021-10-24 Impact factor: 2.362