Stereotactic iodine-125 brachytherapy for the treatment of WHO grades II and III gliomas located in the central sulcus region

Abstract

Background. Resection of gliomas located in eloquent brain areas remains a neurosurgical challenge. The reported incidence of transient or permanent neurological deficits after microsurgery in eloquent brain ranges 20%-100%, or 0%-47% among contemporary neurosurgical series. The aim of this study was to assess the feasibility of stereotactic brachytherapy (SBT) as a local treatment alternative to microsurgical resection for patients with gliomas in highly eloquent areas, located in the central sulcus region (CSR). Method. Between1997and 2010,60patientswithWorld Health Organization (WHO) grades II and III gliomas located in the CSR were treated with SBT (iodine-125 seeds; cumulative therapeutic dose, 50-65 Gy). Following SBT, WHO grade III glioma patients additionally received percutaneous radiotherapy (median boost dose, 25.2 Gy).We evaluated procedure-related complications, clinical outcome, and progression-free survival. Results. Procedure-related mortality was zero.Within 30 days of SBT, 3 patients (5%) had transient neurological deficits, and 8 patients (13%) had temporarily increased seizure activity. One patient (1.6%) deteriorated permanently. Space-occupying cysts (6 patients) and radiationnecrosis (1 patient) developed after a median of 38 monthsandrequiredsurgical intervention.Seizure activity, rated 12 months following SBT, decreased in 82% of patients( Engel classes I-III). Medianprogression-free survivalswere62.2± 19.7months(grade II gliomas)and26.1± 17.9 months (grade III gliomas). Conclusions. Compared with microsurgical resection, SBTharbors a lowriskof procedural complications, isminimally invasive, andseemsto beaneffective local treatment option for patients with inoperable, eloquentWHOgrade IIandIII gliomas in theCSR.However, the value ofSBTfor treating gliomas still needs to be determined in prospective, randomized studies. © The Author(s) 2013.