Permanent Iodine-125 Brachytherapy Research Articles

Secondary bladder cancer after permanent iodine-125 brachytherapy for prostate cancer

Secondary bladder cancer after permanent iodine-125 brachytherapy for prostate cancer

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

BackgroundThe 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.MethodsBetween 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.ResultsNo 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.ConclusionsPermanent 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.

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 (HGG) after surgery remains poor. Iodine-125 brachytherapy emerges 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 therapy method even without radiotherapy and/or chemotherapy, for the progressive or recurrent HGG after gross total surgery. Methods: Between March 2004 and August 2016, 58 patients with progressive or recurrent HGG after gross total surgery were included in this study. 29 of them received radiotherapy and/or chemotherapy, and then permanent iodine-125 brachytherapy (SRCI group). 29 of them received permanent iodine-125 brachytherapy alone (SI group). Follow-up was carried out 1, 3, 6 months and then 1, 2, 3, 5 years after iodine-125 implantation. Median overall survival (OS), progression-free survival (PFS), procedure-related complications and clinical outcome were evaluated. Findings: 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 21and 7 months in the SRCI group. No significant differences were found. Age and KPS were the independent prognostic factors of OS. Age, KPS and histology were the independent prognostic factors of PFS. Interpretation: Permanent iodine-125 brachytherapy could be used as an effective therapy method even without radiotherapy and/or chemotherapy, for the progressive or recurrent HGG after gross total surgery. Funding Statement: This work was supported by the National Science Foundation for Youths of China (NO. 81901800). Declaration of Interests: The authors stated: There are no conflicts of interest to declare. Ethics Approval Statement: The study was approved by the Institutional Ethics Review Boards of each hospital with the requirement of informed consent waived.

Evaluation of organ doses following prostate treatment with permanent brachytherapy seeds: a Geant4 Monte Carlo simulation study

This study aimed to evaluate the absorbed doses received by the organs at risk (OARs) following prostate treatment with permanent Iodine-125 (125I) brachytherapy seeds. In order to simulate an enlarged abnormal prostate due to malignancy, the MIRD5 adult male anthropomorphic phantom (readily available in the Geant4 Monte Carlo package) was modified by increasing the prostate volume to 35 cm3. The permanent seeds were constructed with an outer cylindrical dimension of 4.5 mm (length) × 0.8 mm (diameter). The effects of various activity per seed (0.5, 0.6 and 0.8 mCi), number of seeds (62, 78, 94 and 110 seeds) and radionuclides, i.e. Palladium-103 (103Pd), 125I and Cesium-131 (131Cs), towards the absorbed dose to the OARs (i.e. rectum, urinary bladder and both testicles) were investigated. In this study, prostate dose of up to 237 Gy was simulated, which resulted in 11 Gy dose to rectum, 7 Gy to urinary bladder and 4 Gy to each testicle. The doses were considered as reasonable, given the low dose rate nature of the treatment, allowing tissue repair for the OARs. Optimal seeds arrangement was found to consist of 78 or fewer seeds, as it resulted in the lowest dose to the OARs. For similar prostate dose, 103Pd resulted in the lowest dose to the OARs, followed by 125I and 131Cs. Permanent seed brachytherapy allows high dose to be delivered to the prostate, while ensuring minimal dose to the OARs.

Permanent Seed Brachytherapy for Low Risk Prostate Cancer, Long Term Outcome, and Urinary Toxicity

Low dose rate seed brachytherapy is an established treatment modality for low risk prostate cancer (CaP). Herein, we report long term biochemical control and urinary toxicity from a single institution. Data from a prospectively-collected institutional database was used, completed with retrospective chart reviews. All patients with low-risk CaP (NCCN criteria) who underwent ultrasound-guided permanent iodine-125 brachytherapy from March 1999 to December 2005 were included. Urinary function was evaluated by the International Prostate Symptom Score (IPSS). PSA relapse was defined by Phoenix Criteria (Nadir + 2 ng/ml). Time to IPSS return to baseline score ±3 was recorded. 582 patients with a median age of 64 years were included. Median initial PSA was 5.5 ng/ml (0.3-10). 66% and 34% were T1 and T2a, respectively. Gleason score was 6 (96%) and <6 (4%). Prescription dose was 145Gy, with a median V100 coverage of 94% (IQR [Inter-quartile range] 89-97%) and median D90 of 157Gy (IQR 144-171 Gy). With a median follow up of 131 months (IQR 94-149 months), 27 patients showed biochemical failure (4.6%), and PSA bounce was detected in 38 cases (7%). Biochemical progression-free rates were 97% (96-98%), 96% (94-97%), and 94% (91-96%) at 5, 10, and 15 years, respectively. Median PSA level at 5, 10 and 15 years was 0.06, 0.05 and 0.018 ng/ml, respectively. PSA relapses were observed out to 148 months. At 1, 5, 10 and 15 years, 5.5%, 16.5%, 39.5% and 89.2% of patients were lost to PSA follow up. Median baseline IPSS score was 5. In 515 (88.5%) patients IPSS returned to baseline, with a median time to return-to-baseline of 9 months. The proportion of return-to-baseline at 1, 2, 5, and 10 years was 62%, 75%, 88%, and 90%, respectively. 22 (4%) patients required post-implant urinary catheter. After 3, 6 and 12 months, 9 (1.5%), 6 (1%) and 4 (0.7%) patients continued to be catheterized. Within the limits of retrospective analysis, permanent seed brachytherapy for low risk prostate cancer is an effective treatment modality with low urinary toxicity. Treatment resulted in excellent long-term biochemical control although late relapses were observed.

Permanent seed brachytherapy for low risk prostate cancer, long term outcome, and urinary toxicity.

66 Background: Low dose rate seed brachytherapy is an established treatment modality for low risk prostate cancer (CaP). Herein, we report long term biochemical control and urinary toxicity from a single institution. Methods: Data from a prospectively-collected institutional database was used, completed with retrospective chart reviews. All patients with low-risk CaP (NCCN criteria) who underwent ultrasound-guided permanent iodine-125 brachytherapy from March 1999 to December 2005 were included. Urinary function was evaluated by the International Prostate Symptom Score (IPSS). PSA relapse was defined by Phoenix Criteria (nadir + 2 ng/ml). Time to IPSS return-to-baseline score ±3 was recorded. Results: 582 patients with a median age of 64 years were included. Median initial PSA was 5.5 ng/ml (0.3-10). 66% and 34% were T1 and T2a, respectively. Gleason score was 6 (96%) and &lt; 6 (4%). Prescription dose was 145Gy, with a median V100 coverage of 94% (IQR [interquartile range] 89-97%) and median D90 of 157Gy (IQR 144-171 Gy). With a median follow up of 131 months (IQR 94-149 months), 27 patients showed biochemical failure (4.6%), and PSA bounce was detected in 38 cases (7%). Biochemical progression-free rates were 97% (96-98%), 96% (94-97%), and 94% (91-96%) at 5, 10, and 15 years, respectively. Median PSA level at 5, 10 and 15 years was 0.06, 0.05 and 0.018 ng/ml, respectively. PSA relapses were observed out to 148 months. At 1, 5, 10 and 15 years, 5.5%, 16.5%, 39.5% and 89.2% of patients were lost to PSA follow up. Median baseline IPSS score was 5. In 515 (88.5%) patients IPSS returned to baseline, with a median time to return-to-baseline of 9 months. The proportion of return-to-baseline at 1, 2, 5, and 10 years was 62%, 75%, 88%, and 90%, respectively. 22 (4%) patients required post-implant urinary catheter. After 3, 6 and 12 months, 9 (1.5%), 6 (1%) and 4 (0.7%) patients continued to be catheterized. Conclusions: Within the limits of retrospective analysis, permanent seed brachytherapy for low risk prostate cancer is an effective treatment modality with low urinary toxicity. Treatment resulted in excellent long-term biochemical control although late relapses were observed.

Statin use is associated with decreased prostate cancer recurrence in men treated with brachytherapy

Recent in vitro and in vivo evidence has suggested that statin medications may have anticancer activity. We sought to determine whether statin use was associated with improved clinical outcome in men treated with brachytherapy for prostate cancer. A database of men with prostate cancer treated with permanent Iodine-125 brachytherapy between January 1999 and February 2009 was retrospectively analyzed. Standard guidelines (i.e., American Brachytherapy Society selection criteria) were used for selecting patients for brachytherapy. Biochemical failure was defined using the Phoenix definition. From a total of 247 men with prostate adenocarcinoma treated with brachytherapy, 174 patients (70 %) were identified as using statin medications, either during initial visit or during follow-up. Median PSA follow-up was 51 months after date of implant (range 9.4-140.35). Overall biochemical failure rate was 7.3 % (18 patients). On univariate analysis, statin use was associated with significantly improved freedom from biochemical failure [hazard ratio (HR) 0.28; 95 % CI 0.10-0.72; p < 0.01 by log-rank test]. In multivariate Cox analysis performed with the variables statin use, pretreatment PSA, clinical T stage, Gleason score, and D90 or V100, statin use remained significantly associated with improved freedom from biochemical failure (HR 0.288; 95 % CI 0.086-0.886; p = 0.0299). Statin use was associated with a significant improvement in freedom from biochemical failure in this cohort of men treated with brachytherapy for prostate cancer. Further investigation into the favorable effect of statin use on brachytherapy and radiation therapy in general is warranted, including prospective trials.

Mid-term outcome of permanent prostate iodine-125 brachytherapy in Japanese patients

To analyze mid-term oncological outcomes of low-dose rate brachytherapy in Japanese patients. Between 2003 and 2010, 604 consecutive patients with clinically localized prostate cancer were treated with low-dose rate brachytherapy at Jikei University Hospital in Tokyo, Japan. Median follow up was 48 months. Of these patients, 260 (43%) were treated with neoadjuvant therapy, 45 (7.5%) with adjuvant hormonal therapy and 75 (12.4%) with supplemental external beam radiation therapy. Biochemical recurrence was defined as the prostate-specific antigen nadir plus 2 ng/mL. Of the 604 patients, 219 (36.2%) were low risk, 361 (59.8%) were intermediate risk and 24 (4.0%) had high-risk disease. The median biologically effective dose was 174.4 Gy2. At 8 years, biochemical recurrence-free survival, cancer-specific survival, and overall survival were 82.2%, 100% and 95.6%, respectively. Biochemical recurrence-free survival at 8 years was 89.9%, 79.4% and 52.5%, for the low-, intermediate-, and high-risk groups, respectively. Biochemical recurrence-free survival for the high-risk group was significantly lower than the low- and intermediate-risk groups (P < 0.001). Biochemical recurrence-free survival did not differ significantly by biologically effective dose stratification. In multivariate analysis, younger age (P = 0.045), higher prostate-specific antigen (P = 0.004), higher Gleason score (P = 0.006) and higher clinical T stage (P = 0.008) were significant covariates associated with biochemical recurrence. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than low-dose rate brachytherapy monotherapy (P = 0.0021 and 0.010). Just four patients experienced G3 genitourinary or gastrointestinal toxicity. Low-dose rate brachytherapy results in excellent mid-term oncological outcomes and acceptable toxicity in Japanese patients. In our experience, biologically effective dose does not represent a significant predictor for biochemical recurrence.

Factors Influencing Urinary Symptoms 10 Years After Permanent Prostate Seed Implantation

We investigated the factors that influenced urinary symptoms in the first 10 years after prostate brachytherapy. A total of 1,932 men were treated with prostate brachytherapy alone or with external beam irradiation and followed a mean of 6.8 years. The influence of pretreatment American Urological Association symptom score (7 or less, 8 to 19, 20 or greater), external beam radiotherapy, (125)I or (103)Pd, biological effective dose, age, prostate size and hormone therapy on the change in American Urological Association symptom score (11,491) was compared. The mean change from initial score (7.4) was 11.4, 5.5, 3.3, 2.7, 1.5, 1.2, 1, 1, 1, 1, 1.3 and 1.4 points at 3, 6 months and 1 to 10 years, respectively (p <0.001). Factors that resulted in a greater increase in urinary symptoms at year 1 were low pretreatment score (p <0.001), no hormonal therapy (p <0.001), younger age (p = 0.046) and higher biological effective dose (p = 0.025). At 10 years patients with an initial score of 20 or greater had an average decrease of 11 points compared to a decrease of 0.9 for an initial score of 8 to 19 and an increase of 2.7 for an initial score of 7 or less (p <0.001). On linear regression the scores at 1 year were influenced by initial score (p <0.001), biological effective dose (p = 0.022), prostate size (p <0.001) and hormonal therapy (p = 0.009). At 10 years only the pretreatment score remained significant (p <0.001). There is minimal change in mean American Urological Association symptom score (1.4 points) 10 years after prostate brachytherapy. Patients presenting with high initial scores have the greatest improvement from baseline. Biological effective dose, external beam radiotherapy, hormonal therapy, isotope, patient age and prostate size do not appear to influence long-term urinary symptoms.

Stereotactically-guided Permanent Iodine-125 Brachytherapy for Recurrent Pan-invasive Pituitary Macroadenomas

Stereotactically-guided Permanent Iodine-125 Brachytherapy for Recurrent Pan-invasive Pituitary Macroadenomas

Experimental and theoretical dosimetry of a new polymer encapsulated iodine‐125 source—SmartSeed: Dosimetric impact of fluorescence x rays

The detailed study of a new permanent iodine-125 brachytherapy source, SmartSeed, is presented in this article. It is the first iodine seed made with biocompatible polymer and is manufactured by the IBt-Bebig group. Three dosimetric studies have been performed: The first one used thermoluminescent detectors in a solid water phantom with NIST (National Institute of Standards and Technology, USA) calibrated seeds, and two separate studies were of Monte Carlo photon transport calculations (MCNP5 code). The TG-43U1 protocol was applied to derive dosimetric parameters for clinical applications. The radial dose function g(r) was determined at different distances ranging from 0.5 to 10 cm; and the anisotropy function F(r, theta) at angles ranging from 0 degrees to 350 degrees in 10 degrees increments. Monte Carlo calculations were performed in liquid water to obtain values for lambda, g(r), F(r, theta), and phi(an)(r) as recommended by the TG-43U1 protocol for use in treatment planning system software. SmartSeed's biocompatible polymer capsule permits fluorescence x rays (3, 5, and 12 keV), generated by lead glass marker, to be present in the emission spectrum, influencing the dose rate constant. The impact on near field dosimetry in water from these x rays was also investigated and reported. The capsule also attenuates iodine-125 energies much less than typical titanium encased sources, resulting in a highly isotropic source. SmartSeed has a dose rate constant of 0.895 +/- 7.3% cGy h(-1) U(-1), a radial dose function nearly identical to the IBt-Bebig model I25.S06 seed, and a highly isotropic dose distribution. Fluorescence x rays account for the relatively low value of lambda, yet their variable contribution to dosimetry arising from seed dimensional uncertainties is estimated to be < 0.2%.

The impact of perineural invasion on biochemical outcome after permanent prostate iodine-125 brachytherapy

Purpose Perineural invasion (PNI) in prostate biopsies is associated with increased risk of higher Gleason score and worse pathologic stage. We report the influence of PNI in biochemical no evidence of disease (bNED) survival after 125I prostate brachytherapy (BT). Methods and Materials Pathology reports of 700 men with localized prostate cancer who underwent 125I prostate BT in 1999–2008 were reviewed. The presence or absence of PNI in the biopsy was documented in 339 men. Clinical, treatment, and dosimetric parameters, along with PNI status, were evaluated for bNED survival, defined by “nadir + 2” definition. Results Of the 339 patients, 87% had favorable risk and 13% intermediate risk. PNI was present in 89 patients (26%). After a median followup of 32 months, there were five biochemical failures (4: +PNI and 1: −PNI), of which one was local failure (+PNI). Actuarial 5-year bNED survival for the entire group was 97.0% (92.9% for +PNI; 99.2% for −PNI). In univariate analysis age, pretreatment prostate-specific antigen, Gleason score 7, and intermediate risk group predicted for worse biochemical outcome, whereas the presence of PNI showed a trend toward significance ( p = 0.06). Some of the regression algorithms failed to converge because of low event rates. Conclusions We report excellent biochemical control in 339 men treated with 125I prostate BT. The presence of PNI showed a trend toward significance in predicting 5-year bNED survival but did not impact on local control and should not influence the decision to recommend BT for localized prostate cancer.

Factor Analysis of the Expanded Prostate Cancer Index Composite in a Patient Group after Primary (External Beam Radiotherapy and Permanent Iodine-125 Brachytherapy) and Postoperative Radiotherapy for Prostate Cancer

Background: The Expanded Prostate Cancer Index Composite questionnaire is widely used as a comprehensive assessment of health-related quality of life issues in prostate cancer management, distinguishing urinary, bowel, sexual, hormonal domains. The primary purpose of this study was to assess the factor structure of this questionnaire. Patients and Methods: A principal component analysis with orthogonal (varimax) rotation was conducted on data collected from 418 patients after primary (external beam radiotherapy and permanent iodine-125 brachytherapy) and postoperative radiotherapy for prostate cancer. Results: Health-related quality of life scores well demonstrated differences in subpopulations before radiotherapy and different toxicity profiles of specific radiotherapy concepts. The extraction of 12 factors accounted for 75.5% of the variance. With exception of the sexual domain, a strong dependence between the function in a domain and the related bother was found. The concept to discriminate urinary incontinence and urinary irritation/ obstruction subscales was supported. However, the items ‘bleeding with urination’ and ‘bloody stools’ have loaded on separate factors. After separation of the items of the function and bother subscales, a 4-factor solution was confirmed to be optimal, respectively. Conclusion: The obtained factor structure corresponds to the original Expanded Prostate Cancer Index Composite subscales. Minor divergences have been found, depicting especially items concerning ‘incontinence’ and ‘bleeding’ as distinct aspects of a domain.

Surgical resection and permanent iodine-125 brachytherapy for brain metastases

To evaluate the efficacy and toxicity of surgical resection and permanent iodine-125 brachytherapy without adjuvant whole brain radiation therapy (WBRT) for brain metastases. Forty patients were treated with permanent iodine-125 brachytherapy at the time of resection of brain metastases from 1997 to 2003. Actuarial freedom from progression (FFP) and survival were measured from the date of surgery and estimated using the Kaplan-Meier method, with censoring at last imaging for FFP endpoints. The median survival was 11.3 months overall, 12.0 months in 19 patients with newly diagnosed brain metastases and 7.3 months in 21 patients with recurrent brain metastases. Twenty-two patients (55%) remained free of progression of brain metastases, three failed at the resection cavity (including one with leptomeningeal dissemination), two failed with leptomeningeal spread only, and 13 failed elsewhere in the brain including two who also had leptomeningeal disease. The 1-year resection cavity FFP probabilities were 92%, 86% and 88%; and brain FFP probabilities were 29%, 43% and 37% for the newly diagnosed, recurrent and all patients, respectively. Symptomatic necrosis developed 7.4-40.0 months (median, 19.5 months) after brachytherapy in 9 patients (23%), confirmed by resection in 6 patients. Excellent local control was achieved using permanent iodine-125 brachytherapy for brain metastasis resection cavities, although there is a high risk of radiation necrosis over time. These data support consideration of permanent brachytherapy without adjuvant WBRT as a treatment option in patients with symptomatic or large newly diagnosed or recurrent brain metastases.

Phase I Trial of Gross Total Resection, Permanent Iodine-125 Brachytherapy, and Hyperfractionated Radiotherapy for Newly Diagnosed Glioblastoma Multiforme

To evaluate the feasibility of gross total resection and permanent I-125 brachytherapy followed by hyperfractionated radiotherapy for patients with newly diagnosed glioblastoma. From April 1999 to May 2002, 21 patients with glioblastoma multiforme were enrolled on a Phase I protocol investigating planned gross total resection and immediate placement of permanent I-125 seeds, followed by postoperative hyperfractionated radiotherapy to a dose of 60 Gy at 100 cGy b.i.d., 5 days per week. Median age and Karnofsky performance status were 50 years (range, 32-65 years) and 90 (range, 70-100), respectively. Toxicity was assessed according to Radiation Therapy Oncology Group criteria. Eighteen patients completed treatment according to protocol. The median preoperative tumor volume on magnetic resonance imaging was 18.6 cm(3) (range, 4.4-41.2 cm(3)). The median brachytherapy dose measured 5 mm radially outward from the resection cavity was 400 Gy (range, 200-600 Gy). Ten patients underwent 12 reoperations, with 11 of 12 reoperations demonstrating necrosis without evidence of tumor. Because of high toxicity, the study was terminated early. Median progression-free survival and overall survival were 57 and 114 weeks, respectively, but not significantly improved compared with historical patients treated at University of California, San Francisco, with gross total resection and radiotherapy without brachytherapy. Treatment with gross total resection and permanent I-125 brachytherapy followed by hyperfractionated radiotherapy as performed in this study results in high toxicity and reoperation rates, without demonstrated improvement in survival.

Association of neoadjuvant hormonal therapy with adverse health-related quality of life after permanent iodine-125 brachytherapy for localized prostate cancer

Objectives To characterize the influence of neoadjuvant hormonal therapy (NHT) on health-related quality of life after permanent iodine-125 brachytherapy (BT) for prostate cancer. Methods A cross-sectional survey using the Expanded Prostate Cancer Index Composite health-related quality-of-life instrument was administered to 134 consecutive patients a median of 29 months after BT. A separate group of 111 patients with comparable demographic characteristics without any prior treatment for prostate cancer rendered the baseline information (control group). The scores and symptom rates were compared. The effect of NHT was tested for independence in a multivariate analysis. Results In contrast to patients who received NHT, prostatic edema was hardly detectable 30 days after implantation in patients who received BT alone (comparing median preimplant and postimplant volumes), resulting in a greater dose to the prostate and anterior rectal wall. However, compared with the control group and the patients who received BT alone, the addition of NHT to BT led to lower health-related quality-of-life scores in all domains. Score differences of more than 10 points with a statistical significance were found for the urinary bother, sexual function/bother, and hormonal function/bother domains. Apart from the sexual function scores (patient age shown to be the crucial factor), the influence of NHT remained independent on multivariate analysis. Conclusions The results stress the need for well-considered administration of NHT before BT and the need for reporting the use of NHT in studies dealing with BT-related toxicity.

Ultrasonically guidedinterstitial brachytherapy for prostate cancer: Care of the patient in ambulatory surgery

The diagnosis of prostate cancer at any age can strike fear in a man and his family. One treatment for early stage prostate cancer that is gaining renewed popularity is ultrasonically guided permanent iodine-125 or palladium-103 interstitial brachytherapy or seed implantation. This procedure permits concentrated, accurate radiation to the prostate while reducing the probability of radiation injury to adjacent tissue. A well-tolerated outpatient procedure, it is associated with negligible complications, and is the most overall cost-effective treatment option for early stage prostate cancer today. Nurses who are knowledgeable about the treatment plan and procedure play a pivotal role in teaching, preparing, and caring for patients during all phases of the treatment process. Their care and reassurance help reduce anxiety for patients and families during a difficult time in their lives.

Brachytherapy: A Viable Alternative in the Management of Basal Meningiomas

Thirteen patients with intracranial meningiomas of the skull base were treated with one or more high-activity iodine-125 seeds. In 11 patients, the seeds were implanted stereotactically under local anesthesia. A minimum dose of 100 to 500 Gy was delivered to the tumor at a dose rate of 5 to 25 cGy/h. Indications for this procedure included recurrence after initial surgery or as the primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 15 months. Nine of 11 patients (82%) without calcification in their meningiomas achieved complete response. The remaining 4 patients-2 with calcification and 2 without--achieved partial response. No early or late complications were observed. We conclude from our experience that both recurrent and primary meningiomas of the skull base can be treated effectively with permanent iodine-125 brachytherapy.