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Open Access Commentary

Stereotactic iodine-125 brachytherapy for brain tumors: temporary versus permanent implantation

Maximilian I Ruge1*, Philipp Kickingereder1, Stefan Grau2, Harald Treuer1, Volker Sturm1 and Juergen Voges3

Author Affiliations

1 Department for Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne, 50937, Germany

2 Department for Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne, 50937, Germany

3 Department of Stereotactic Neurosurgery, University of Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany

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Radiation Oncology 2012, 7:94  doi:10.1186/1748-717X-7-94

Published: 19 June 2012

Abstract

Stereotactic brachytherapy (SBT) has been described in several publications as an effective, minimal invasive and safe highly focal treatment option in selected patients with well circumscribed brain tumors <4 cm. However, a still ongoing discussion about indications and technique is hindering the definition of a clear legitimation of SBT in modern brain tumor treatment. These controversies encompass the question of how intense the irradiation should be delivered into the target volume (dose rate). For instance, reports about the use of high does rate (HDR) implantation schemes ( >40 cGy/h) in combination with adjuvant external beam radiation and/or chemotherapy for the treatment of malignant gliomas and metastases resulted in increased rates of radiation induced adverse tissue changes requiring surgical intervention. Vice versa, such effects have been only minimally observed in numerous studies applying low dose rate (LDR) regiments (3–8 cGy/h) for low grade gliomas, metastases and other rare indications. Besides these observations, there are, however, no data available directly comparing the long term incidences of tissue changes after HDR and LDR and there is, furthermore, no evidence regarding a difference between temporary or permanent LDR implantation schemes. Thus, recommendations for effective and safe implantation schemes have to be investigated and compared in future studies.

Keywords:
Stereotactic Brachytherapy; Permanent/Temporary Low Dose Rate Implantation; Brain Tumors