Safety and efficacy of Cesium-131 brachytherapy for brain tumors.

TitleSafety and efficacy of Cesium-131 brachytherapy for brain tumors.
Publication TypeJournal Article
Year of Publication2023
AuthorsBander ED, Kelly A, Ma X, Christos PJ, A Wernicke G, Stieg PE, Trichter S, Knisely JPS, Ramakrishna R, Schwartz TH
JournalJ Neurooncol
Date Published2023 Jun
KeywordsBrachytherapy, Brain Neoplasms, Cesium Radioisotopes, Glioma, Humans, Lung Neoplasms, Meningeal Neoplasms, Meningioma, Necrosis, Neoplasm Recurrence, Local, Retrospective Studies, Treatment Outcome

BACKGROUND: The introduction of Cesium-131 (Cs-131) as a radiation source has led to a resurgence of brachytherapy for central nervous system (CNS) tumors. The aim of this study was to evaluate the safety and efficacy of the largest cohort of Cs-131 patients to-date.

METHODS: A retrospective review of all CNS tumors treated with resection and adjuvant Cs-131 brachytherapy at New York-Presbyterian/Weill Cornell from 2010 to 2021 was performed. Overall survival (OS) and local control (LC) were assessed with Kaplan-Meier methodology. Univariable analysis was conducted to identify patient factors associated with local recurrence or radiation necrosis.

RESULTS: Adjuvant Cs-131 brachytherapy following resection was performed in 119 patients with a median follow-up time of 11.8 (IQR 4.7-23.6) months and a mean of 22.3 +/-30.3 months. 1-year survival rates were 53.3% (95%CI 41.9-64.6%) for brain metastases (BrM), 45.9% (95%CI 24.8-67.0%) for gliomas, and 73.3% (95%CI 50.9-95.7%) for meningiomas. 1-year local control rates were 84.7% for BrM, 34.1% for gliomas, and 83.3% for meningiomas (p < 0.001). For BrM, local control was superior in NSCLC relative to other BrM pathologies (90.8% versus 76.5%, p = 0.039). Radiographic radiation necrosis (RN) was identified in 10 (8.4%) cases and demonstrated an association with smaller median tumor size (2.4 [IQR 1.8-2.7 cm] versus 3.1 [IQR 2.4-3.8 cm], p = 0.034). Wound complications occurred in 14 (11.8%) patients.

CONCLUSIONS: Cs-131 brachytherapy demonstrated a favorable safety and efficacy profile characterized by high rates of local control for all treated pathologies. The concept of brachytherapy has seen a resurgence given the excellent results when Cs-131 is used as a source.

Alternate JournalJ Neurooncol
PubMed ID37249824