Abstract
Purpose:
To evaluate the efficacy of interstitial radiosurgery (IRS) for pineal parenchymal tumors (PPTs).
Patients and Methods:
18 consecutively admitted patients (twelve male and six female, age range 6–68 years, median age 34 years) with PPTs (eight pineocytomas, ten malignant PPTs) were treated at the authors’ institution with IRS using stereotactically guided iodine-125 seed implantation (125I-IRS) as either primary or salvage therapy. The cumulative tumor surface dose ranged from 40 to 64 Gy. Adjuvant radiotherapy of the whole brain or the craniospine was done in patients with grade III and grade IV PPT. The median follow-up period was 57.4 months (range 6–134 months).
Results:
Overall actuarial 5- and 8-year survival rates after IRS were 100% and 86% for pineocytomas, and the overall actuarial 5-year survival rate was 78% for high-grade PPTs. Follow-up magnetic resonance imaging showed complete remission in 72% (13/18) and partial remission in 28% (5/18) of the cases. One patient developed an out-of-field relapse 4 years after partial remission of a pineocytoma, which had already been treated with IRS. There was no treatment-related mortality. Treatment-related morbidity occurred in two patients only.
Conclusion:
This study indicates that stereotactic 125I-IRS for the management of PPTs is quite efficient and safe. Due to the low rate of side effects, IRS may develop into an attractive alternative to microsurgery in de novo diagnosed pineocytomas. In malignant PPTs, IRS may be routinely applied in a multimodality treatment schedule supplementary to conventional irradiation.
Zusammenfassung
Ziel:
Die Wirksamkeit der stereotaktischen interstitiellen Radiochirurgie (IRS) zur Behandlung von Pinealisparenchymtumoren (PPTs) wurde analysiert.
Patienten und Methodik:
18 Patienten (zwölf männlich und sechs weiblich, Alter 6–68 Jahre, medianes Alter 34 Jahre) mit einem PPT (acht Pineozytome, zehn maligne PPTs) wurden in der Klinik der Autoren durch eine stereotaktisch geführte interstitielle Radiochirurgie mittels Implantation von Jod-125-Seeds (125I-IRS) behandelt. Die Behandlung erfolgte entweder als Primar- oder als Salvage-Therapie. Die kumulative Tumoroberflächendosis variierte von 40 bis 64 Gy. Adjuvante Ganzhirnbestrahlung oder Bestrahlung der Wirbelsäule wurde bei den Patienten mit malignen PPTs durchgeführt. Die mediane Nachbeobachtungszeit betrug 57,4 Monate (6–134 Monate).
Ergebnisse:
Die 5- und 8-Jahres-Uberlebensraten nach IRS für Pineozytome betrugen 100% bzw. 86%, und die 5-Jahres-Uberlebensrate nach IRS für die höhergradigen PPTs lag bei 78%. Eine komplette Remission wurde in 72% der Fälle (13/18) und eine partielle Remission in 28% der Fälle (5/18) erzielt. Ein Patient entwickelte 4 Jahre nach partieller Remission eines Pineozytoms ein „out-of-field“-Rezidiv. Dieses Rezidiv wurde ebenfalls mittels stereotaktisch geführter IRS behandelt. Es wurde keine behandlungsbedingte Mortalität beobachtet. Eine behandlungsbedingte Morbidität trat bei zwei Patienten auf.
Schlussfolgerung:
Die Studie zeigt, dass die Behandlung von PPTs durch stereotaktisch geführte 125I-IRS sicher und effektiv ist. Aufgrund der geringen Nebenwirkungen kann sich diese Behandlung zu einer guten Alternative zur Mikrochirurgie bei de novo diagnostizierten Pineozytomen entwickeln. Bei malignen PPTs kann diese Methode als Ergänzung in ein multimodales Behandlungskonzept einbezogen werden.
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Maarouf, M., El Majdoub, F., Bührle, C. et al. Pineal Parenchymal Tumors. Strahlenther Onkol 186, 127–134 (2010). https://doi.org/10.1007/s00066-010-2096-3
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DOI: https://doi.org/10.1007/s00066-010-2096-3
Key Words
- Brachytherapy
- Interstitial radiosurgery
- Pineal parenchymal tumors
- Pineoblastoma
- Pineocytoma
- Stereotactic iodine-125 seed implantation