Safety and efficacy of Cesium-131 brachytherapy for brain tumors.

Abstract

BACKGROUND:

The introduction of Cesium-131 (Cs-131) as a radiation source has led to a resurgence of brachytherapy for central nervous system (CNS) tumors. The aim of this study was to evaluate the safety and efficacy of the largest cohort of Cs-131 patients to-date.

METHODS:

A retrospective review of all CNS tumors treated with resection and adjuvant Cs-131 brachytherapy at New York-Presbyterian/Weill Cornell from 2010 to 2021 was performed. Overall survival (OS) and local control (LC) were assessed with Kaplan-Meier methodology. Univariable analysis was conducted to identify patient factors associated with local recurrence or radiation necrosis.

RESULTS:

Adjuvant Cs-131 brachytherapy following resection was performed in 119 patients with a median follow-up time of 11.8 (IQR 4.7-23.6) months and a mean of 22.3 +/-30.3 months. 1-year survival rates were 53.3% (95%CI 41.9-64.6%) for brain metastases (BrM), 45.9% (95%CI 24.8-67.0%) for gliomas, and 73.3% (95%CI 50.9-95.7%) for meningiomas. 1-year local control rates were 84.7% for BrM, 34.1% for gliomas, and 83.3% for meningiomas (p < 0.001). For BrM, local control was superior in NSCLC relative to other BrM pathologies (90.8% versus 76.5%, p = 0.039). Radiographic radiation necrosis (RN) was identified in 10 (8.4%) cases and demonstrated an association with smaller median tumor size (2.4 [IQR 1.8-2.7 cm] versus 3.1 [IQR 2.4-3.8 cm], p = 0.034). Wound complications occurred in 14 (11.8%) patients.

CONCLUSIONS:

Cs-131 brachytherapy demonstrated a favorable safety and efficacy profile characterized by high rates of local control for all treated pathologies. The concept of brachytherapy has seen a resurgence given the excellent results when Cs-131 is used as a source.

• Authors: Evan D Bander, Alexander Kelly, Xiaoyue Ma, Paul J Christos, A Gabriella Wernicke, Philip E Stieg, Samuel Trichter, Jonathan P S Knisely, Rohan Ramakrishna, Theodore H Schwartz
• Journal: Journal of neuro-oncology (J Neurooncol) Vol. 163 Issue 2 Pg. 355-365 (Jun 2023) ISSN: 1573-7373 [Electronic] United States
• PMID: 37249824 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Cesium-131
• Cesium Radioisotopes

Topics

• Humans
• Cesium Radioisotopes
• Treatment Outcome
• Meningioma (surgery)
• Brachytherapy (adverse effects, methods)
• Brain Neoplasms (surgery)
• Retrospective Studies
• Meningeal Neoplasms (surgery)
• Lung Neoplasms
• Glioma
• Necrosis (etiology)
• Neoplasm Recurrence, Local (surgery)