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Surgical Technique and Clinically Relevant Resection Cavity Dynamics Following Implantation of Cesium-131 (Cs-131) Brachytherapy in Patients With Brain Metastases.

TitleSurgical Technique and Clinically Relevant Resection Cavity Dynamics Following Implantation of Cesium-131 (Cs-131) Brachytherapy in Patients With Brain Metastases.
Publication TypeJournal Article
Year of Publication2016
AuthorsA Wernicke G, Lazow SP, Taube S, Yondorf MZ, Kovanlikaya I, Nori D, Christos P, Boockvar JA, Pannullo S, Stieg PE, Schwartz TH
JournalOper Neurosurg (Hagerstown)
Volume12
Issue1
Pagination49-60
Date Published2016 03
ISSN2332-4252
KeywordsBrachytherapy, Brain, Brain Neoplasms, Cesium Radioisotopes, Follow-Up Studies, Humans, Neoplasm Recurrence, Local, Radiosurgery, Retrospective Studies, Treatment Outcome
Abstract

BACKGROUND: Cesium-131 (Cs-131) brachytherapy is used to reduce local recurrence of resected brain metastases. In order to ensure dose homogeneity and reduce risk of radiation necrosis, inter-seed distance and cavity volume must remain stable during delivery.

OBJECTIVE: To investigate the efficacy of the "seeds-on-a-string" technique with intracavitary fibrin glue in achieving cavity volume stability.

METHODS: We placed intra-operative Cs-131 brachytherapy in 30 cavities post-resection of brain metastases. Seeds-on-a-string were placed like barrel staves within the cavity with fibrin glue. Serial MRI imaging occurred post-operatively. Pre-operative tumor volumes were compared with post-operative cavity volumes to evaluate volume stability. Thirty patients who underwent post-resective stereotactic radiosurgery (SRS) were used as a control group for volumetric comparison.

RESULTS: Cs-131 and SRS patients exhibited consistent cavity shrinkage over the median 110-day follow-up (p<.001), with total median shrinkage of 56.5% (Cs-131) and 84.8% (SRS). During the first month when ~88% of Cs-131 dosage is delivered, however, there was non-significant volume decrease in the Cs-131 group (median 22.0%; p=.063), while SRS patients showed significantly more shrinkage (46.7%; p=.042). No events of radiation necrosis occurred in either group.

CONCLUSION: Cs-131 patients exhibited significantly less cavity shrinkage than SRS patients during the first critical month with 88% Cs-131 dose delivery. This significant difference in shrinkage suggests that the intracavitary seeds-on-a-string technique facilitates increased cavity stability, promoting more homogenous dose delivery.

DOI10.1227/NEU.0000000000000986
Alternate JournalOper Neurosurg (Hagerstown)
PubMed ID27774500
PubMed Central IDPMC5068574
Grant ListKL2 RR024997 / RR / NCRR NIH HHS / United States
KL2 TR002385 / TR / NCATS NIH HHS / United States
UL1 TR000457 / TR / NCATS NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States