Interstitial brachytherapy using stereotactic implanted (125)iodine seeds for recurrent medulloblastoma

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2011-10, Vol.23 (8), p.532-537
• Main Authors: El Majdoub, F, Simon, T, Hoevels, M, Berthold, F, Sturm, V, Maarouf, M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brachytherapy; Cerebellar Neoplasms - pathology; Cerebellar Neoplasms - radiotherapy; Child; Female; Follow-Up Studies; Humans; Iodine Radioisotopes - therapeutic use; Male; Medulloblastoma - pathology; Medulloblastoma - radiotherapy; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Prognosis; Salvage Therapy; Survival Rate; Young Adult
• ISSN: 1433-2981
• DOI: 10.1016/j.clon.2011.02.009

To evaluate the efficacy of interstitial brachytherapy using (125)iodine ((125)I) seeds for the treatment of recurrent multimodal treated medulloblastoma. Between September 1989 and August 2009, 12 patients (female:male=3:9, median age 19 years, range 7-55 years) with 23 recurrent medulloblastomas underwent interstitial brachytherapy using (125)I seeds. Before brachytherapy, all patients underwent microsurgical resection; six patients underwent a combined adjuvant treatment consisting of craniospinal irradiation and chemotherapy; three received craniospinal irradiation alone and two received chemotherapy alone. One patient was treated by surgery alone. The median tumour volume was 4.9ml (range 0.4-44.2ml), the median tumour surface dose 50Gy (range 32-50Gy) and the median implantation time 42 days (range 42-90 days). A median follow-up of 26 months was available (range 5-116 months). After brachytherapy, nine of 23 tumours (39%) presented a complete remission, nine (39%) a partial remission and five (22%) stable disease on magnetic resonance images. The neurological status improved in six patients and remained unchanged in four. Two patients deteriorated: one developed spinal metastasis and another a treatment-related adverse radiation effect. Ten patients died due to disseminated disease despite local tumour control. The median survival after treatment was 15 months (range 5-68 months). Our results show a good response of recurrent medulloblastoma after interstitial brachytherapy. High rates of tumour remission were yielded with low rates of treatment-related morbidity. Thus, (125)I seed brachytherapy should be considered as a treatment option for recurrent medulloblastoma.