Permanent I-125 brain stem implants in children |
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Authors: | P J Chuba Lucia Zamarano Merlin Hamre Kanta Bhambhani Alexa Canady Mary Beth Guys Amgad Matter Genghis Portillo Suzanne Chung-bin James Fontanesi |
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Institution: | (1) Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA, US;(2) Department of Neurosurgery, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA, US;(3) Department of Pediatric Hematology/ Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA, US;(4) Department of Medical Physics, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA, US |
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Abstract: | Between 1988 and 1997, 28 children have had iodine-125 implants for CNS tumors performed in our institution. Ten had stereotactic
implantation in the brain stem region, and nine had the diagnosis of brain stem glioma (8 diffuse pontine, 1 midbrain tumor).
Their ages ranged from 1.8 to 12 years. All patients had histological confirmation of malignancy (7 high-grade glioma, 2 low-grade
glioma, 1 PNET). Diffuse pontine glioma patients received external beam radiation (50 Gy) followed by a fractionated stereotactic
boost of 3 Gy×4 fractions. After 4–6 weeks, patients were reevaluated for stereotactic interstitial I-125 therapy. The planned
implant dose was 82.9 Gy to the enhancing tumor (4 cGy per h). Preliminary results indicated that no surgical complications
were associated with the catheter placement. Four patients have died (7–9 months from diagnosis) and four patients remain
alive (5–38 months from diagnosis, median 10 months). Two autopsies confirmed the presence of progressive glioblastoma multiforme
and intralesional necrosis. In one patient who received an implant alone for midbrain LGA, necrosis without tumor was found
on biopsy after 36 months. He was successfully treated with hyperbaric oxygen therapy. The implementation of permanent I-125
implants appears to have a role in the management of pediatric CNS malignancy. This study confirms the results of previous
reports regarding the safety of stereotactic interstitial brachytherapy in the brain stem. Tumor control for patients with
high-grade brain stem glioma remains poor even with high focal radiation doses.
Received: 10 May 1998 |
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Keywords: | Brain stem glioma Iodine-125 implant |
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