High-activity125I interstitial irradiation in the treatment of pediatric central nervous system tumors: A pilot study

James Fontanesi, Richard L. Heideman, Michael Muhlbauer, Raymond Mulhern, Robert A. Sanford, Edwin C. Douglass, Edward Kovnar, Judith J. Ochs, John F. Kuttesch, Douglas Tai, Larry E. Kun

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Malignant pediatric tumors of the central nervous system (CNS) have a poor prognosis, with local failure rates as high as 50%. In an attempt to improve local tumor control, we used stereotactic interstitial therapy with125I implants in patients with recurrent/secondary or newly diagnosed CNS malignancies. Catheters were placed using computed tomography (CT) guidance; computerized dosimetry was completed with the aid of orthogonal films. Implants delivered 1,000 cGy/day to the tumor periphery (0.5 cm beyond the boundary of enhancement on CT scans), to a total dose of 60 Gy. Hyperfractionated external beam irradiation (HEBI), started 2-4 weeks after removal of implants, delivered total doses of 66-70.4 Gy in 110-cGy fractions twice daily to a 3-cm margin around the implant volume. Eight of the 11 patients with newly diagnosed tumors also received 48.4 Gy HEBI to the craniospinal axis. Tumor regression was noted at 2 months after implantation in the 4 patients treated for recurrent/secondary tumors; local progression was subsequently documented in 2 cases at 6 and 20 months after implantation, while a third patient died 6 months after implantation with no evidence of local recurrence. The remaining recurrent/secondary tumor patient has no evidence of active recurrence 15 months after implantation. Local control was maintained in 9 of the patients treated for primary tumors for a median of 27 months (range 15 to 48+ months). The two local failures occurred at 5 and 7 months after implantation. Six patients are alive without evidence of progressive disease (median = 23 months after implantation). There were no severe acute toxicities, but 7 patients later developed histologically confirmed tumor necrosis. Quality of life assessment (QLA) following initial primary therapy with implantation was evaluated utilizing an established criteria and found to be excellent with only one child showing marked QLA score decrease which was related to neurosurgical intervention for radiation-induced necrosis and dysfunctional family social situation. This small series suggests that stereotacticl25I implantation followed by HEBI merits further evaluation in selected children with supratentorial malignant lesions.

Original languageEnglish (US)
Pages (from-to)289-298
Number of pages10
JournalPediatric Neurosurgery
Volume22
Issue number6
DOIs
StatePublished - Jan 1 1955

Fingerprint

Central Nervous System Neoplasms
Pediatrics
Neoplasms
Therapeutics
Necrosis
Craniospinal Irradiation
Tomography
Quality of Life
Recurrence
Catheters
Central Nervous System
Radiation

Keywords

  • <sup>125</sup>I
  • Brain tumors
  • Interstitial implants
  • Pediatric tumors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

Cite this

High-activity125I interstitial irradiation in the treatment of pediatric central nervous system tumors : A pilot study. / Fontanesi, James; Heideman, Richard L.; Muhlbauer, Michael; Mulhern, Raymond; Sanford, Robert A.; Douglass, Edwin C.; Kovnar, Edward; Ochs, Judith J.; Kuttesch, John F.; Tai, Douglas; Kun, Larry E.

In: Pediatric Neurosurgery, Vol. 22, No. 6, 01.01.1955, p. 289-298.

Research output: Contribution to journalArticle

Fontanesi, J, Heideman, RL, Muhlbauer, M, Mulhern, R, Sanford, RA, Douglass, EC, Kovnar, E, Ochs, JJ, Kuttesch, JF, Tai, D & Kun, LE 1955, 'High-activity125I interstitial irradiation in the treatment of pediatric central nervous system tumors: A pilot study', Pediatric Neurosurgery, vol. 22, no. 6, pp. 289-298. https://doi.org/10.1159/000120918
Fontanesi, James ; Heideman, Richard L. ; Muhlbauer, Michael ; Mulhern, Raymond ; Sanford, Robert A. ; Douglass, Edwin C. ; Kovnar, Edward ; Ochs, Judith J. ; Kuttesch, John F. ; Tai, Douglas ; Kun, Larry E. / High-activity125I interstitial irradiation in the treatment of pediatric central nervous system tumors : A pilot study. In: Pediatric Neurosurgery. 1955 ; Vol. 22, No. 6. pp. 289-298.
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AU - Fontanesi, James

AU - Heideman, Richard L.

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AU - Mulhern, Raymond

AU - Sanford, Robert A.

AU - Douglass, Edwin C.

AU - Kovnar, Edward

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AU - Kuttesch, John F.

AU - Tai, Douglas

AU - Kun, Larry E.

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N2 - Malignant pediatric tumors of the central nervous system (CNS) have a poor prognosis, with local failure rates as high as 50%. In an attempt to improve local tumor control, we used stereotactic interstitial therapy with125I implants in patients with recurrent/secondary or newly diagnosed CNS malignancies. Catheters were placed using computed tomography (CT) guidance; computerized dosimetry was completed with the aid of orthogonal films. Implants delivered 1,000 cGy/day to the tumor periphery (0.5 cm beyond the boundary of enhancement on CT scans), to a total dose of 60 Gy. Hyperfractionated external beam irradiation (HEBI), started 2-4 weeks after removal of implants, delivered total doses of 66-70.4 Gy in 110-cGy fractions twice daily to a 3-cm margin around the implant volume. Eight of the 11 patients with newly diagnosed tumors also received 48.4 Gy HEBI to the craniospinal axis. Tumor regression was noted at 2 months after implantation in the 4 patients treated for recurrent/secondary tumors; local progression was subsequently documented in 2 cases at 6 and 20 months after implantation, while a third patient died 6 months after implantation with no evidence of local recurrence. The remaining recurrent/secondary tumor patient has no evidence of active recurrence 15 months after implantation. Local control was maintained in 9 of the patients treated for primary tumors for a median of 27 months (range 15 to 48+ months). The two local failures occurred at 5 and 7 months after implantation. Six patients are alive without evidence of progressive disease (median = 23 months after implantation). There were no severe acute toxicities, but 7 patients later developed histologically confirmed tumor necrosis. Quality of life assessment (QLA) following initial primary therapy with implantation was evaluated utilizing an established criteria and found to be excellent with only one child showing marked QLA score decrease which was related to neurosurgical intervention for radiation-induced necrosis and dysfunctional family social situation. This small series suggests that stereotacticl25I implantation followed by HEBI merits further evaluation in selected children with supratentorial malignant lesions.

AB - Malignant pediatric tumors of the central nervous system (CNS) have a poor prognosis, with local failure rates as high as 50%. In an attempt to improve local tumor control, we used stereotactic interstitial therapy with125I implants in patients with recurrent/secondary or newly diagnosed CNS malignancies. Catheters were placed using computed tomography (CT) guidance; computerized dosimetry was completed with the aid of orthogonal films. Implants delivered 1,000 cGy/day to the tumor periphery (0.5 cm beyond the boundary of enhancement on CT scans), to a total dose of 60 Gy. Hyperfractionated external beam irradiation (HEBI), started 2-4 weeks after removal of implants, delivered total doses of 66-70.4 Gy in 110-cGy fractions twice daily to a 3-cm margin around the implant volume. Eight of the 11 patients with newly diagnosed tumors also received 48.4 Gy HEBI to the craniospinal axis. Tumor regression was noted at 2 months after implantation in the 4 patients treated for recurrent/secondary tumors; local progression was subsequently documented in 2 cases at 6 and 20 months after implantation, while a third patient died 6 months after implantation with no evidence of local recurrence. The remaining recurrent/secondary tumor patient has no evidence of active recurrence 15 months after implantation. Local control was maintained in 9 of the patients treated for primary tumors for a median of 27 months (range 15 to 48+ months). The two local failures occurred at 5 and 7 months after implantation. Six patients are alive without evidence of progressive disease (median = 23 months after implantation). There were no severe acute toxicities, but 7 patients later developed histologically confirmed tumor necrosis. Quality of life assessment (QLA) following initial primary therapy with implantation was evaluated utilizing an established criteria and found to be excellent with only one child showing marked QLA score decrease which was related to neurosurgical intervention for radiation-induced necrosis and dysfunctional family social situation. This small series suggests that stereotacticl25I implantation followed by HEBI merits further evaluation in selected children with supratentorial malignant lesions.

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