Brachytherapy as an Adjuvant for Recurrent Atypical and Malignant Meningiomas. Issue 5 (November 2019)

• Record Type: Journal Article
• Authors: Koch, Matthew J; Agarwalla, Pankaj K; Royce, Trevor J; Shih, Helen A; Oh, Kevin; Niemierko, Andrezj; Mauceri, Thomas C; Curry, William T; Barker, Frederick G; Loeffler, Jay S
• Is Part Of: Neurosurgery. Volume 85:Issue 5(2019)
• Publication Date: 2019-11
• Subjects: Radiosurgery -- Radiation therapy -- Brachytherapy -- Malignant meningioma -- Atypical meningioma; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz115
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: : Recurrent atypical and malignant meningiomas have poor outcomes with surgical therapy alone. Neither adjuvant chemotherapy nor postoperative radiation therapy remedies this problem. OBJECTIVE: : To evaluate our experience with the treatment of 15 patients treated with I‐125 or Cs‐131 brachytherapy radiation seeds as an adjuvant in these difficult cases. METHODS: : Patients with high‐grade recurrent meningioma who underwent resection and intraoperative placement of brachytherapy seeds at our institution from 2002 to 2014 were identified and studied by retrospective chart review. RESULTS: : Fifteen patients with median age of 68.8 yr were treated with I‐125 (n = 13) or Cs‐131 (n = 2) brachytherapy seeds for cases of recurrent, grade II (n = 8), or grade III (n = 7) meningioma at our institution from 2002 to 2014. These lesions originated from a variety of locations including, convexity (3), falcine (3), frontal (2), occipital (1), parietal (2), 2 sphenoid wing (2), and temporal (2), based recurrent meningiomas. Patients had a median of 2 prior open surgical interventions and received local radiation therapy with a median dose of 55 Gy prior to brachytherapy. Survival at 2.5 yr was 56% for grade II and 17% for grade III lesions. Survival was significantly associated with patient age but not tumoral pathology. Forty percent of patients required reoperations for wound complications following brachytherapy. CONCLUSION: : Brachytherapy with implantation of permanent radiation seeds provides a viable alternative treatment for recurrent meningioma while carrying a significant clinical risk of wound infection and need for reoperation. GRAPHICAL ABSTRACT: : Figure. Graphical Abstract. No Caption available.