Recurrent high-level meningioma optional intraradiator as an auxiliary treatment

Atypical meningioma (WHO class II) and malignant meningioma (WHO Class III) have high recurrence rates and limited treatment after recurrenceIt can be surgically removed again, but it is difficult to remove it completely; Brachytherapy (brachytherapy, BT), which places radioactive implants in tumor cavity for so-called "internal radiation" can reduce radiation exposure to surrounding brain tissueMatthew JKoch, neurosurgery at Massachusetts General Hospital, usa, and others report relapses of atypical and malignant meningiomas when re-surgically removed, the cavity is built into iodine-125 (I-125) or cesium-131 (Cs-131) radiation particles, published online in April 2019study methods
the authors retrospectively analyzed 15 cases of atypical or malignant meningioma recurrence from 2002 to 2014, and placed so-called radioactive seeds containing I-125 or Cs-131 radioactive particles in the tumor cavity under the epidural after the maximum safe removal of the tumor; Radioactive seeds are arranged in square spline in the tumor cavity, with a distance of 1.0cm between seeds throughout the tumor cavity (Figure 1)The activity of I-125 radioactive seeds on the day of implantation was 0.5mCi/Seed, and the activity of Cs-131 radioactive seeds on the day of implantation was 4.09mCi/seedThe final dose of I-125 is 100Gy and the final dose of Cs-131 is 80GyPostoperative CT scans assess seed spacing and placement dosesFigure 1Ct scan image after radioactive seeds are placed in the tumor cavityOf the 15 high-level meninges treatedBT, WHO Class II 8 and WHO III 7; The lesions are located in 3 cases of the convex surface of the brain, 3 cases of the brain side, and 9 cases of the cranial basePostoperative pathology diagnosis are atypical or malignant meningioma, no transparent cells, ropes, transverse muscle or nipple-like subtypesPrior toBT treatment, the median number of surgeries in WHO Class II patients was 1 and the median number of SURGERy in WHO Class III patients was 21 patient received only stereotactic photon radiation therapy prior to BT treatment From the first surgery to BT time 2-255 months, the median 14 months I-125 radioactive seeds were implanted in the tumor cavity of 13 patients, with a median of 39 radioactive seeds, and 2 patients were implanted with Cs-131 radioactive seeds, 17 and 20 each the results the study ended with a recurrence of tumors in all but 2 WHO Class II patients Six cases (40%) were re-operated, both due to infection or open wounds, and the number of re-surgeries ranged from 1 to 14 A total of 10 deaths, including 6 WHO III and 4 WHO II The total survival of patients initially diagnosed with WHO class II meningioma is 3-30 years, and the total survival of WHO Class III patients is 4-13 years A single-factor analysis showed that the age of BT treatment patients was significantly correlated with total survival (P-0.05), while tumor classification, sex, excision and radioseed number were not significantly correlated with total survival The multi-factor analysis showed that both age and tumor classification were significantly related to total survival conclusions
the final authors believe that brachytherapy is a rescue treatment for the recurrence of atypical or malignant meningioma, but doctors must pay attention to the serious risk that brachytherapy can lead to wound collapse and infection.