Interstitial brachytherapy of primary brain tumors

Preliminary report

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✓ Ten patients harboring inaccessible, slow-growing or recurrent malignant primary brain tumors were treated by the stereotaxic implantation of a radionuclide seed — iridium-192 (192Ir) or gold-198 (198Au) — either permanent or removable. The strength for 192Ir seeds was selected to deliver 10,000 to 12,000 rads to the periphery of the tumor, and that for 198Au seeds to deliver 4000 to 7500 rads. Three of the six patients treated with 192Ir showed objective responses lasting 8, 11, and 12 months, respectively; and one patient's disease stabilized for 18 months. Three of the four treated with 198Au showed responses lasting 5 months, 6 months, and 2 years, respectively. Because of the higher dose-rate attainable with 198Au, removable implants of this material are more effective against the faster-growing malignant tumors.

Another radionuclide, iodine-125 (125I), is now being tested against brain tumors. The radioactivity of 125I is high; but because its gamma emission is less energetic by a factor of 10 than that of 198Au or 192Ir, its radiation field is concentrated within a radius of 2.5 cm or less. This low-energy gamma emission also makes it easier to protect medical personnel and the patients' families against the nuclide when 125I is used.

Article Information

Address reprint requests to: Yoshio Hosobuchi, M.D., The Editorial Office, Department of Neurological Surgery, 350 Parnassus Avenue, Suite 807, San Francisco, California 94117.

© AANS, except where prohibited by US copyright law.

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    Case 10. Computerized tomography (CT) scans (axial) showing a glioblastoma multiforme that recurred in the left frontal lobe of a 50-year-old woman. The tumor is shown before (A) and after (B) stereotaxic implantation of 198Au, by which an additional 5500 rads was delivered. The patient's hemiparesis and dysphasia improved markedly for 5 months, but an axial CT scan made 5 months after brachytherapy (C) shows the recurrent left frontal glioblastoma.

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