Interstitial irradiation of cerebral gliomas with stereotactically implanted iodine-125 seeds

Ninety-seven consecutive patients with primarily inoperable or only partially resectable gliomas have been analysed retrospectively. Mean tumour surface doses of 70 Gy (low grade gliomas) and 56 Gy (high grade gliomas) have been applied with stereotactically implanted Iodine-125 seeds at low dose rates. Patients with a glioma grade III or grade IV and permanent seed implantation additionally received a fractionated external beam irradiation. With mean follow-up times of 55.8 months (glioma grade I), 51 months (glioma grade II) and 59.6 months (glioma grade III) the estimated mean survival probabilities are 105 months, 102 months and 65.7 months respectively. In the glioma grade IV group the estimated mean survival time has been 15.6 months after continuous interstitial irradiation (response rate: 36%). Temporary interstitial irradiation in cases with a glioma grade IV (dose rate: 2.1 Gy/day) caused initial tumour shrinkage in 77%. Neurological deficits following radiation induced vasogenic oedema were reversible in 2 patients and irreversible in another 2 patients. 6 years after the Iodine-125 implantation and continuous interstitial irradiation 1 patient developed a severe localised radiation necrosis.