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Palavani LB, Verly G, Borges P, Neto L, Almeida M, Leite M, Oliveira LB, Batista S, Bertani R, Polverini AD, de Macedo Filho L, Paiva W. Beyond surgical resection: evaluating stereotactic brachytherapy iodine-125 for low-grade gliomas: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:617. [PMID: 39276262 DOI: 10.1007/s10143-024-02839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/30/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024]
Abstract
Stereotactic Brachytherapy Iodine-125 (SBT I-125) has been investigated by some studies for the treatment of lowgrade gliomas. We performed a meta-analysis to assess the efficacy and safety of SBT I-125 Brachytherapy for treatment of patients with Low-Grade Gliomas. PubMed, Cochrane, Web of Science, and EMBASE databases were searched for randomized and observational studies. This systematic review and meta-analysis was conducted according to the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. We used relative risk (RR) with 95% confidence intervals and random effects model to compare the effects of I-125 SBT treatment on the interest outcomes. We evaluated heterogeneity using I2 statistics; we considered heterogeneity to be significant if the p-value was less than 0.05 and I2 was higher than 35%. We performed statistical analysis using the software R (version 4.2.3). A total of 20 studies with a cohort of 988 patients with low grade gliomas who received SBT I-125 as a treatment option. The pooled analysis evidenced: (1) Complication rate of 10% (95% CI: 7-12%; I² = 60%); (2) 5-year PFS of 66% (99% CI: 45-86%; I²= 98%); (3) 10-year PFS was 66% (99% CI: 45-86%; I²= 98%); (4) Malignant transformation rate of 26% (95% CI: 8-45%; I²=0); (5) Mortality of 33% (95% CI: 15-51%; I² = 0%). Our systematic review and meta-analysis of SBT I-125 for low-grade gliomas have revealed significant concerns regarding its safety and efficacy. Despite a proportion of patients remaining progression-free, elevated rates of complications and mortality cast doubt on the intervention's reliability. Future research should prioritize long-term follow-up studies, standardized protocols, and comparative effectiveness research.
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Affiliation(s)
- Lucca B Palavani
- Max Planck University Center, Rua Eurico Primo Venturine, 379, Jardim Pedroso, Indaiatuba, 13343-000, São Paulo, Brazil.
| | - Gabriel Verly
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Borges
- Technical-Educational Foundation Souza Marques, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis Neto
- Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Miguel Almeida
- Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
| | - Marianna Leite
- Faculty of Medicine Santa Marcelina, São Paulo, São Paulo, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Allan Dias Polverini
- Neurosurgical Oncology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Li X, Zhou H, Mou K, Zheng Y, Li H, Ren P, Ye H, Lin S, Pang H, Wu J, Xiang L. Risk Factors for Operation Complications of High Dose Rate 3-Dimensional Interstitial Brachytherapy for Lung Cancer. Clin Lung Cancer 2023:S1525-7304(23)00059-1. [PMID: 37149479 DOI: 10.1016/j.cllc.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The risk factors for operation complications of high-dose-rate dimensional (3D) interstitial brachytherapy for lung malignant tumors are still unclear. We aimed to provide a reliable reference for the preoperative safety assessment of interstitial brachytherapy. PATIENTS AND METHODS We analyzed the degree and incidence of operational complications in 120 eligible patients with lung carcinoma who underwent computed tomography (CT)-guided HDR interstitial brachytherapy. Univariate and multivariate analyses were used to study the relationships between patient-related factors, tumor-related factors, operation-related factors, and operational complications. RESULTS The most frequent complications of CT-guided HDR interstitial brachytherapy were pneumothorax and hemorrhage. In univariate analysis, smoking, emphysema, distance of implanted needles through the normal lung tissue, number of implanted needle adjustments, and distance of the lesion from the pleura were the risk factors for pneumothorax; the tumor size, distance of the tumor from the pleura, number of implanted needle adjustments, and distance of the implanted needle through the normal lung tissue were risk factors for hemorrhage. In multivariate analysis, the depth of the implanted needle through the normal lung tissue and distance of the lesion from the pleura were independent risk factors for pneumothorax. Tumor size, number of implanted needle adjustments, and distance through normal lung tissue were independent risk factors for hemorrhage. CONCLUSION This study provides a reference for the clinical treatment of lung cancer by analyzing the risk factors for complications of interstitial brachytherapy.
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Affiliation(s)
- Xiaoyue Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Huan Zhou
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kelin Mou
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yun Zheng
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongxia Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Peirong Ren
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hua Ye
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingbo Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Li Xiang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Zhang M, Liu G, He X, Chu C. Dosimetric evaluation of iodine-125 brachytherapy for brain tumors using MR guidance combined with a three-dimensional non co-planar template. Brachytherapy 2023; 22:242-249. [PMID: 36628801 DOI: 10.1016/j.brachy.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the consistency between preoperative and postoperative dosimetry when 125I brachytherapy for brain tumors is performed with magnetic resonance (MR) guidance and a three-dimensional non co-planar template (3DNPT). METHODS AND MATERIALS Thirty patients with brain tumors (metastatic or gliomas) underwent radioactive 125I seed implantation. A preoperative treatment plan was determined with MR imaging, and the operation was done under 3DNPT assistance and MR guidance. The dosimetry was verified postoperatively based on postoperative CT-MR fusion images. Postoperative dosimetric parameters and implant quality indices were defined and compared with those in the preoperative treatment plan. Furthermore, a comparison of preoperative and postoperative doses to normal brain tissues and organs at risk was also performed. RESULTS All mean postoperative dosimetries were calculated. Target coverage parameters D90, D100, %CTV100, %CTV150, and %CTV200 were 143.6 cGy, 76.6 cGy, 88.2%, 63.1%, and 41.4%, respectively. The values of implant quality indices CI, EI, and HI were 0.75, 0.14, and 0.28, respectively. No significant differences between most preoperative and postoperative dosimetric parameters were found (p > 0.05). The differences were also insignificant for organs at risk. Postoperative %CTV150 and %CTV200 were higher than the preoperative, whereas postoperative HI was significantly lower than in the treatment plan. CONCLUSIONS Magnetic resonance guidance combined with 3DNPT allows accurate positioning and direction in 125I brachytherapy for brain tumors. However, seed distribution and dose homogeneity require further improvement.
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Affiliation(s)
- Menglong Zhang
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Ganzhou, Jiangxi, China.
| | - Guitao Liu
- Department of Respiratory and Critical Care Medicine, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiangmeng He
- Department of Interventional MRI, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Cunkun Chu
- Library, Shandong First Med Univ & Shandong Acad Med Sci, Tai'an, Shandong, China
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CT-MR Image Fusion for Post-Implant Dosimetry Analysis in Brain Tumor Seed Implantation- a Preliminary Study. DISEASE MARKERS 2022; 2022:6310262. [PMID: 35620270 PMCID: PMC9129983 DOI: 10.1155/2022/6310262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 12/17/2022]
Abstract
Purpose To calculate and evaluate postimplant dosimetry (PID) with CT-MR fusion technique after brain tumor brachytherapy and compare the result with CT-based PID. Methods and Materials 16 brain tumor patients received MR-guided intervention with Iodine-125 (125I) seed implantation entered this preliminary study for PID evaluation. Registration and fusion of CT and MR images of the same patients were performed one day after operation. Seeds identification and targets delineation were carried out on CT, MR, and CT-MR fusion images, each. The number and location of seeds on MR or CT- MR fusion images were compared with those of actually implanted seeds. Clinical target volume (CTV) and dosimetric parameters such as %D90, %V100 and external V100 were measured and calculated. In addition, the correlation of the fusion to CT CTV ratio and other factors were analyzed. Results The numbers of fusion seeds were not significantly different compared with reference seeds (t =1.76, p >0.05). The difference between reference seeds numbers and truly extracted MR seeds numbers was statistically significant (t =3.91, p <0.05). All dosimetric parameters showed significant differences between the two techniques (p <0.05). The mean CTV delineated on fusion images was 34.3 ± 33.6, smaller than that on CT images. The mean values of external V100, %V100 and %D90 on fusion images were larger than those on CT images. Correlation analysis showed that the fusion-CT V100 ratio was positively and significantly correlated with the fusion-CT volume ratio. Conclusions This preliminary study indicated that CT-MR fusion-based PID exhibited good accuracy for 125I brain tumor brachytherapy dosimetry when compared to CT-based PID and merits further research to establish best-outcome protocols.
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Evaluation of the efficacy of CT-guided 3D template-assisted 125I seed implantation in the treatment of unresectable STS: a multicenter retrospective study. Sci Rep 2022; 12:3731. [PMID: 35260674 PMCID: PMC8904573 DOI: 10.1038/s41598-022-07729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
To observe the safety and efficacy of CT-guided 3D template-assisted radioactive 125I seed implantation in the treatment of unresectable advanced soft tissue sarcoma (STS). Sixty-two patients who underwent continuous 3D template-assisted radioactive 125I seed implantation for the treatment of unresectable advanced STS from August 2017 to August 2018 were selected from four tumor treatment centers for retrospective analysis. The postoperative adverse reactions and tumor response were recorded, and the postoperative complications were observed and treated at the same time. The overall survival (OS) rate was determined. All patients successfully completed 125I seed implantation. In practice, the median number of puncture needles used during the operation was 20, and the median number of 125I particles was 88. There were no statistical differences in the relative dosimetry parameters before and after the operation (P > 0.05). Tumor evaluation was performed 6 months after the operation. The effective rate was 61.3%, and the local control rate was 93.5%. As of March 2020, the 1-year survival rate was 85.2%, and the 2-year survival rate was 49.0%. The OS was 23 months. CT-guided 3D template-assisted 125I seed implantation for the treatment of unresectable STS has a high local control rate, thereby further prolonging the OS of patients with unresectable STS.
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Chelliah SS, Paul EAL, Kamarudin MNA, Parhar I. Challenges and Perspectives of Standard Therapy and Drug Development in High-Grade Gliomas. Molecules 2021; 26:1169. [PMID: 33671796 PMCID: PMC7927069 DOI: 10.3390/molecules26041169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/18/2022] Open
Abstract
Despite their low incidence rate globally, high-grade gliomas (HGG) remain a fatal primary brain tumor. The recommended therapy often is incapable of resecting the tumor entirely and exclusively targeting the tumor leads to tumor recurrence and dismal prognosis. Additionally, many HGG patients are not well suited for standard therapy and instead, subjected to a palliative approach. HGG tumors are highly infiltrative and the complex tumor microenvironment as well as high tumor heterogeneity often poses the main challenges towards the standard treatment. Therefore, a one-fit-approach may not be suitable for HGG management. Thus, a multimodal approach of standard therapy with immunotherapy, nanomedicine, repurposing of older drugs, use of phytochemicals, and precision medicine may be more advantageous than a single treatment model. This multimodal approach considers the environmental and genetic factors which could affect the patient's response to therapy, thus improving their outcome. This review discusses the current views and advances in potential HGG therapeutic approaches and, aims to bridge the existing knowledge gap that will assist in overcoming challenges in HGG.
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Affiliation(s)
- Shalini Sundramurthi Chelliah
- Brain Research Institute Monash Sunway, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.C.); (E.A.L.P.); (M.N.A.K.)
- School of Science, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Ervin Ashley Lourdes Paul
- Brain Research Institute Monash Sunway, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.C.); (E.A.L.P.); (M.N.A.K.)
| | - Muhamad Noor Alfarizal Kamarudin
- Brain Research Institute Monash Sunway, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.C.); (E.A.L.P.); (M.N.A.K.)
| | - Ishwar Parhar
- Brain Research Institute Monash Sunway, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (S.S.C.); (E.A.L.P.); (M.N.A.K.)
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EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol 2020; 18:170-186. [PMID: 33293629 PMCID: PMC7904519 DOI: 10.1038/s41571-020-00447-z] [Citation(s) in RCA: 1046] [Impact Index Per Article: 209.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 01/16/2023]
Abstract
In response to major changes in diagnostic algorithms and the publication of mature results from various large clinical trials, the European Association of Neuro-Oncology (EANO) recognized the need to provide updated guidelines for the diagnosis and management of adult patients with diffuse gliomas. Through these evidence-based guidelines, a task force of EANO provides recommendations for the diagnosis, treatment and follow-up of adult patients with diffuse gliomas. The diagnostic component is based on the 2016 update of the WHO Classification of Tumors of the Central Nervous System and the subsequent recommendations of the Consortium to Inform Molecular and Practical Approaches to CNS Tumour Taxonomy — Not Officially WHO (cIMPACT-NOW). With regard to therapy, we formulated recommendations based on the results from the latest practice-changing clinical trials and also provide guidance for neuropathological and neuroradiological assessment. In these guidelines, we define the role of the major treatment modalities of surgery, radiotherapy and systemic pharmacotherapy, covering current advances and cognizant that unnecessary interventions and expenses should be avoided. This document is intended to be a source of reference for professionals involved in the management of adult patients with diffuse gliomas, for patients and caregivers, and for health-care providers. Herein, the European Association of Neuro-Oncology (EANO) provides recommendations for the diagnosis, treatment and follow-up of adult patients with diffuse gliomas. These evidence-based guidelines incorporate major changes in diagnostic algorithms based on the 2016 update of the WHO Classification of Tumors of the Central Nervous System as well as on evidence from recent large clinical trials.
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Evaluation of radioactive 125I seed implantation for the treatment of refractory malignant tumours based on a CT-guided 3D template-assisted technique: efficacy and safety. BMC Cancer 2020; 20:718. [PMID: 32746784 PMCID: PMC7398391 DOI: 10.1186/s12885-020-07223-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background To observe the medium- and long-term clinical efficacy and safety of radioactive 125I seed implantation for refractory malignant tumours based on CT-guided 3D template-assisted technique. Methods Twenty-five patients with refractory malignant tumours who underwent radioactive 125I seed implantation based on CT-guided 3D template-assisted technique were selected. The post-operative adverse reactions were recorded. The number of puncture needles and particles used in the operation, dosimetric parameters, post-operative physical strength scores, and tumour response were statistically analysed. The overall survival time and survival rate were calculated, and the effect and prognosis were assessed. Results 125I seed implantation was successful in all patients without serious complications. The average number of implanted puncture needles was 17 (19.12 ± 13.00), and the median number of particles was 52 (55.12 ± 32.97). D90 in the post-operative clinical target volume (CTV) (93.24 ± 15.70 Gy) was slightly lower than that in the pre-operative CTV (93.92 ± 17.60 Gy; P > 0.05). The D90 in the post-operative planning target volume (PTV) (142.16 ± 22.25 Gy) was lower than the pre-operative PTV (145.32 ± 23.48 Gy; P > 0.05). The tumour responses at 6 months post-operatively: complete remission (CR), 20% (5/25); partial remission (PR), 48% (12/25); stable disease (SD), 24% (6/25); progressive disease (PD), 8% (2/25); CR + PR, 68% (17/25); and local control rate, 92% (23/25). The 6-, 12-, and 24-month survival rates were 100, 88, and 52%, respectively. The post-operative physical strength score (Karnofsky performance score, KPS) exhibited a gradual trend towards recovery, which rose to the highest value 12 months after implantation and then decreased slightly, but the average score was still > 90 points. There was one intra-operative pneumothorax, and two patients with superficial malignant tumours developed skin ulcerations. Multivariate analysis of prognosis showed that tumour sites and types were independent risk factors affecting survival. The number of needles and particles and template types were not the factors. Conclusions 3D template combined with CT-guided radioactive 125I seed implantation can improve the rational distribution of radiation dose in the tumour target area because accurate radioactive 125I particle implantation was achieved. This technique has fewer complications and can further extend the overall survival and improve the quality of life. Trial registration Registration number: ChiCTR2000034566 2020/7/10 0:00:00 Retrospectively registered.
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Permanent iodine-125 brachytherapy for patients with progressive or recurrent high-grade gliomas. BMC Cancer 2020; 20:591. [PMID: 32580723 PMCID: PMC7315528 DOI: 10.1186/s12885-020-07086-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023] Open
Abstract
Background The prognosis of patients with progressive or recurrent high-grade gliomas (HGGs) after surgery remains poor. Iodine-125 brachytherapy is emerging as a salvage method for the treatment of gliomas. This study aimed to investigate whether permanent iodine-125 brachytherapy could be used as an effective therapeutic method even without radiotherapy and/or chemotherapy for progressive or recurrent HGG after gross total resection. Methods Between March 2004 and August 2016, 58 patients with progressive or recurrent HGG after gross total resection were included in this study. Twenty-nine patients underwent radiotherapy and/or chemotherapy and then permanent iodine-125 brachytherapy (SRCI group). Twenty-nine patients underwent permanent iodine-125 brachytherapy alone (SI group). Follow-up was carried out at 1, 3, and 6 months and then at 1, 2, 3, and 5 years after iodine-125 implantation. The median overall survival (OS) and progression-free survival (PFS), procedure-related complications and clinical outcomes were evaluated. Results No procedure-related fatal events happened. The temporary morbidity rate was 11.9%. The median OS and PFS for patients in the SI group were 22 and 8 months compared with 21 and 7 months in the SRCI group. No significant differences were found. Age and Karnofsky Performance Status (KPS) were independent prognostic factors for OS. Age, KPS and histology were independent prognostic factors for PFS. Conclusions Permanent iodine-125 brachytherapy could be used as an effective therapeutic method even without radiotherapy and/or chemotherapy for progressive or recurrent HGG after gross total resection.
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He X, Liu M, Zhang M, Sequeiros RB, Xu Y, Wang L, Liu C, Wang Q, Zhang K, Li C. A novel three-dimensional template combined with MR-guided 125I brachytherapy for recurrent glioblastoma. Radiat Oncol 2020; 15:146. [PMID: 32513276 PMCID: PMC7282063 DOI: 10.1186/s13014-020-01586-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background At present, the treatment of recurrent glioblastoma is extremely challenging. In this study, we used a novel three-dimensional non-coplanar template (3DNPT) combined with open MR to guide 125I seed implantation for recurrent glioblastoma. The aim of this study was to evaluate the feasibility, accuracy, and effectiveness of this technique. Methods Twenty-four patients of recurrent glioblastoma underwent 3DNPT with open MR-guided 125I brachytherapy from August 2017 to January 2019. Preoperative treatment plan and 3DNPT were made according to enhanced isovoxel T1-weighted MR images. 125I seeds were implanted using 3DNPT and 1.0-T open MR imaging guidance. Dosimetry verification was performed after brachytherapy based on postoperative CT/MR fusion images. Preoperative and postoperative dosimetry parameters of D90, V100, V200, conformity index (CI), external index (EI) were compared. The objective response rate (ORR) at 6 months and 1-year survival rate were calculated. Median overall survival (OS) measured from the date of brachytherapy was estimated by Kaplan-Meier method. Results There were no significant differences between preoperative and postoperative dosimetry parameters of D90, V100, V200, CI, EI (P > 0.05). The ORR at 6 months was 75.0%. The 1-year survival rate was 58.3%. Median OS was 12.9 months. One case of small amount of epidural hemorrhage occurred during the procedure. There were 3 cases of symptomatic brain edema after brachytherapy treatment, including grade three toxicity in 1 case and grade two toxicity in 2 cases. The three patients were treated with corticosteroid for 2 to 4 weeks. The clinical symptoms related to brain edema were significantly alleviated thereafter. Conclusions 3DNPT combined with open MR-guided 125I brachytherapy for circumscribed recurrent glioblastoma is feasible, effective, and with low risk of complications. Postoperative dosimetry matched the preoperative treatment plan. The described method can be used as a novel implantation technique for 125I brachytherapy in the treatment of recurrent gliomas. Trial registration The study was approved by the Institutional Review Board of Shandong Provincial Hospital Affiliated to Shandong University (NSFC:NO.2017–058), registered 1st July 2017.
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Affiliation(s)
- Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Menglong Zhang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | | | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Ligang Wang
- Department of Medical Imaging and Interventional Radiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
| | - Chao Liu
- Department of Tumor Minimally Invasive, Tai'an Central Hospital, Tai'an, Shandong, People's Republic of China
| | - Qingwen Wang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Kai Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China.
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Li F, Xu J, Zhu Y, Sun L, Zhou R. Analysis of Cells Proliferation and MicroRNAs Expression Profile in Human Chondrosarcoma SW1353 Cells Exposed to Iodine-125 Seeds Irradiation. Dose Response 2020; 18:1559325820920525. [PMID: 32362797 PMCID: PMC7180315 DOI: 10.1177/1559325820920525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/11/2020] [Indexed: 12/18/2022] Open
Abstract
Chondrosarcoma is the second most common bone malignancy in adults, and it is often resistant to traditional chemotherapy and radiation therapy. Permanent implantation of iodine-125 (125I) seeds has been explored for the treatment of many types of cancer. In this study, the aim was to investigate the proliferative and microRNA (miRNA) effects of 125I seeds irradiation on human chondrosarcoma SW1353 cells. First, a new in vitro 125I seed irradiation model was established, and cell viability and miRNA microarray assays were performed before and after exposure to the 125I seeds. Cell proliferation was inhibited, and miRNA expression was substantially altered by irradiation exposure. The inhibition of cell proliferation was positively correlated with increased radiation doses, with cells showing the highest total radiation dose 7 days after irradiation. A total of 2549 miRNAs were detected in the SW1353 cells after exposure to 6 Gy of radiation, which included 189 differentially expressed miRNAs (98 upregulated and 91 downregulated). Four miRNAs were found to play important roles in the inhibition of cell proliferation after irradiation exposure, including miR-1224-5p, miR-492, miR-135b-5p, and miR-6839-5p. The target genes of the associated miRNAs mentioned were vascular endothelial growth factor A (VEGFA), C-X-C motif chemokine 12 (CXCL12), mitogen-activated protein kinase kinase kinase kinase 3 (MAP4K3), and apoptosis facilitator Bcl-2-like protein 14 (BCL2L14). Hence, the mitogen-activated protein kinase signaling pathway may be involved in how chondrosarcoma cells respond to 125I seed irradiation.
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Affiliation(s)
- Fusheng Li
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Department of Orthopaedic Oncology, The People's Hospital of Liaoning Province, China Medical University People's Hospital, Shenyang, People's Republic of China
| | - Jia Xu
- Clinical Teaching Experimental Center, Key Laboratory of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, Shenyang, People's Republic of China
| | - Yue Zhu
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Liang Sun
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Soochow University, Suzhou, People's Republic of China
| | - Renyi Zhou
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
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Mohindra P, Beriwal S, Kamrava M. Proposed brachytherapy recommendations (practical implementation, indications, and dose fractionation) during COVID-19 pandemic. Brachytherapy 2020; 19:390-400. [PMID: 32423787 PMCID: PMC7252026 DOI: 10.1016/j.brachy.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA.
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A New Treatment Opportunity for DIPG and Diffuse Midline Gliomas: 5-ALA Augmented Irradiation, the 5aai Regimen. Brain Sci 2020; 10:brainsci10010051. [PMID: 31963414 PMCID: PMC7016657 DOI: 10.3390/brainsci10010051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/19/2022] Open
Abstract
Prognosis for diffuse intrinsic pontine glioma (DIPG) and generally for diffuse midline gliomas (DMG) has only marginally improved over the last ~40 years despite dozens of chemotherapy and other therapeutic trials. The prognosis remains invariably fatal. We present here the rationale for a planned study of adding 5-aminolevulinic acid (5-ALA) to the current irradiation of DIPG or DMG: the 5aai regimen. In a series of recent papers, oral 5-ALA was shown to enhance standard therapeutic ionizing irradiation. 5-ALA is currently used in glioblastoma surgery to enable demarcation of overt tumor margins by virtue of selective uptake of 5-ALA by neoplastic cells and selective conversion to protoporphyrin IX (PpIX), which fluoresces after excitation by 410 nm (blue) light. 5-ALA is also useful in treating glioblastomas by virtue of PpIX's transfer of energy to O2 molecules, producing a singlet oxygen that in turn oxidizes intracellular DNA, lipids, and proteins, resulting in selective malignant cell cytotoxicity. This is called photodynamic treatment (PDT). Shallow penetration of light required for PpIX excitation and resultant energy transfer to O2 and cytotoxicity results in the inaccessibility of central structures like the pons or thalamus to sufficient light. The recent demonstration that keV and MeV photons can also excite PpIX and generate singlet O2 allows for reconsideration of 5-ALA PDT for treating DMG and DIPG. 5-ALA has an eminently benign side effect profile in adults and children. A pilot study in DIPG/DMG of slow uptitration of 5-ALA prior to each standard irradiation session-the 5aai regimen-is warranted.
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Liu S, Wang H, Wang C, Zhang H, Li W, Dong Q, Hu X. Dosimetry verification of 3D-printed individual template based on CT-MRI fusion for radioactive 125I seed implantation in recurrent high-grade gliomas. J Contemp Brachytherapy 2019; 11:235-242. [PMID: 31435430 PMCID: PMC6701383 DOI: 10.5114/jcb.2019.85729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/29/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To verify the accuracy and efficacy of three-dimensional printing individual template (3D-PIT) with computed tomography-magnetic resonance imaging (CT-MRI) fusion for radioactive iodine-125 (125I) seed implantation in high-grade brain gliomas. MATERIAL AND METHODS Between June 2017 and June 2018, 16 patients with recurrent high-grade gliomas (rHGG) underwent radioactive seed implantation with 3D-PIT. The prescribed dose was 120-140 Gy. We compared the dose distribution of the postoperative plan with the preoperative plan. Dose parameters included D90, V100, V200, conformity index (CI), and external index of the target volume (EI). Local control and early complications were also analyzed. RESULTS Sixteen treatment areas were reported in our study. Median gross tumor volume (preoperative) of patients was 64.2 cm3, median needle number was 8, and median number of implanted 125I seeds was 60. For postoperative plans, the median D90, V100, and V200 was 152.1 Gy, 96.8%, and 49.1%, respectively, and 151.7 Gy, 97.0%, and 48.9%, respectively, in preoperative plans. Comparing with the preplanned cases, the dose of the target volume was slightly higher; the high-dose area of the target volume was larger in postoperative cases, but the difference was not statistically significant (p > 0.05). Actual dose conformity of the target volume was greater than preplanned, and the difference was not statistically significant (p > 0.05). Local control was 81.25% and 75% at 3 and 6 months after implantation, respectively. No serious early toxicities were observed. CONCLUSIONS 3D-PIT based on the CT-MRI fusion images can result in good accuracy for positioning and dose distribution in radioactive seed implantation for treatment of rHGG.
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Affiliation(s)
- Shifeng Liu
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong Wang
- Department of Dermatology, Qingdao No. 6 People’s Hospital, Qingdao, China
| | - Congxiao Wang
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hao Zhang
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Li
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Dong
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaokun Hu
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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Velnar T, Bosnjak R. Radiosurgical techniques for the treatment of brain neoplasms: A short review. World J Methodol 2018; 8:51-58. [PMID: 30596035 PMCID: PMC6305523 DOI: 10.5662/wjm.v8.i4.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/06/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy has long been used as an adjunct to neurosurgery for the treatment of malignant and benign intracranial tumors and other intracranial lesions. Intracranial tumors can be irradiated in three different ways: I) fractional radiotherapy, II) stereotactic radiotherapy and III) stereotactic radiosurgery. The third is most often by means of a gamma knife or a specially designed linear accelerator. Additionally, radiosurgery is increasingly used in combination with systemic therapy to treat metastases.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- AMEU-ECM, Maribor 2000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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Swenson S, Minea RO, Tuan CD, Thein TZ, Chen TC, Markland FS. A Novel Venom-Derived Peptide for Brachytherapy of Glioblastoma: Preclinical Studies in Mice. Molecules 2018; 23:molecules23112918. [PMID: 30413113 PMCID: PMC6278533 DOI: 10.3390/molecules23112918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/16/2022] Open
Abstract
We developed a bacterial expression system to produce a recombinant disintegrin, vicrostatin (VCN), whose structure is based on a natural disintegrin isolated from southern copperhead snake venom. Our goal is to develop VCN for potential clinical translation as an anti-cancer agent. VCN is a peptide of 69 amino acids with a single tyrosine residue. We have employed VCN as integrin-targeted radionuclide therapy (brachytherapy) for treatment of glioblastoma (GBM, glioma). GBM is a deadly brain cancer that doesn't discriminate between sexes and knows no age limit. We established that the tyrosine residue in VCN can be radioiodinated with full retention of bioactivity. 131I-VCN was utilized for integrin-targeted radionuclide therapy using mouse models of glioma. The combination of radioiodinated VCN plus temozolomide (a DNA alkylating agent) significantly prolonged survival of glioma-bearing mice. We also obtained similar results using an immunocompetent mouse model and a murine glioma cell line. In summary, as demonstrated in studies reported here we have shown that VCN as targeted radionuclide therapy for GBM has significant translational potential for therapy of this deadly disease.
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Affiliation(s)
- Steve Swenson
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA 90089, USA.
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA 90089, USA.
| | - Radu O Minea
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA 90089, USA.
| | - Cao Duc Tuan
- Faculty of Pharmacy, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam.
| | - Thu-Zan Thein
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA 90089, USA.
| | - Thomas C Chen
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA 90089, USA.
| | - Francis S Markland
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA 90089, USA.
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