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Aneurysm, arachnoiditis and intrathecal Au (gold)
D M Pence1, T H Kim, S H Levitt
1Department of Therapeutic Radiology, Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis 55455.
Summary
Long-term follow-up of medulloblastoma patients treated with intrathecal gold reveals severe complications. No patients survived without adverse effects, and the treatment is strongly discouraged due to risks.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Pediatric Oncology
Background:
- Medulloblastoma is a common pediatric brain tumor.
- Craniospinal irradiation is a standard treatment modality.
- Intrathecal radioactive gold was explored as a treatment option.
Purpose of the Study:
- To evaluate the long-term outcomes and complications of medulloblastoma patients treated with external beam craniospinal irradiation and intrathecal gold.
- To assess the safety and efficacy of intrathecal gold in medulloblastoma treatment over a 20-year period.
Main Methods:
- Retrospective analysis of 14 medulloblastoma patients treated with external beam craniospinal irradiation and intrathecal gold (10-45 mCi).
- 20-year follow-up evaluating survival, disease recurrence, and treatment-related complications.
Main Results:
- Six patients died within 2 years due to persistent disease.
- All surviving patients experienced significant complications.
- Eight survivors developed arachnoiditis and cauda equina syndrome (5-10 years post-treatment).
- Seven survivors developed aneurysms and/or cerebrovascular accidents (9-20 years post-treatment), with four fatal events.
- Intrathecal gold distribution was inhomogeneous, pooling in basal cisterns and cauda equina.
Conclusions:
- Intrathecal gold administration leads to severe, long-term neurotoxicity.
- The inhomogeneous dose delivery complicates treatment efficacy and safety.
- Use of intrathecal gold for medulloblastoma is strongly discouraged due to unacceptable complication rates.