Permanent low-activity iodine-125 implants for cerebral metastases

Area of Science:

• Neurosurgery
• Radiation Oncology
• Medical Physics

Background:

• Metastatic brain tumors often require advanced treatment strategies.
• Large or recurrent tumors may not be suitable for radiosurgery.
• Effective local control and improved survival are critical goals in neuro-oncology.

Purpose of the Study:

• To evaluate the efficacy and safety of permanent iodine-125 (125I) seed implants for metastatic brain tumors.
• To assess survival rates, local tumor control, and complications associated with this treatment modality.
• To determine the potential cost-effectiveness and clinical utility of permanent 125I brachytherapy.

Main Methods:

• Retrospective analysis of 13 patients with metastatic brain tumors treated between 1987 and an unspecified date.
• Patients underwent craniotomy, gross total resection, and permanent implantation of low-activity 125I seeds.
• All patients received external whole-brain radiotherapy; implant doses ranged from 43 Gy to 132 Gy (mean 83 Gy).

Main Results:

• Clinical and radiographic local control was achieved in 9 out of 13 patients.
• Survival ranged from 2 weeks to nearly 9 years, with a median of 9 months.
• Low rates of severe complications were observed, including one bone flap infection and one CSF leak.

Conclusions:

• Permanent 125I seed implants are a viable and potentially cost-effective treatment for large, recurrent metastatic brain tumors.
• The procedure offers good survival, quality of life, and occasional long-term disease control.
• It is recommended for patients requiring further surgical intervention for unresectable or large metastatic lesions.