eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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4/2019
vol. 11
 
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abstract:
Case report

Placement of 131Cs permanent brachytherapy seeds in a large combined cavity of two resected brain metastases in one setting: case report and technical note

Jacelyn Greenwald
,
Shoshana Taube
,
Menachem Z. Yondorf
,
Andrew Smith
,
Albert Sabbas
,
A. Gabriella Wernicke

J Contemp Brachytherapy 2019; 11, 4: 356–360
Online publish date: 2019/08/29
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Large brain metastases are presently treated with surgical resection and adjuvant radiotherapy. However, local control (LC) for large tumors decreases from over 90% to as low as 40% as the tumor/cavity increases. Intraoperative brachytherapy is one of the focal radiotherapy techniques, which offers a convenient option of starting radiation therapy immediately after resection of the tumor and shows at least an equivalent LC to external techniques. Our center has pioneered this treatment with a novel FDA-cleared cesium-131 (131Cs) radioisotope for the resected brain metastases, and published promising results of our prospective trial showing superior results from 131Cs application to the large tumors (90%). We report a 57-year-old male patient, with metastatic hypopharyngeal brain cancer. The patient presented with two metastases in the right frontal and right parietal lobes. Post-resection of these lesions resulted in a large total combined cavity diameter of 5.3 cm, which was implanted with 131Cs seeds. The patient tolerated the procedure well, with 100% local control and 0% radiation necrosis. This case is unique in demonstrating that the 131Cs isotope was not only a convenient option of treating two resected brain metastases in one setting, but also that this treatment option offered excellent long-term LC and minimal toxicity rates.
keywords:

cesium-131, 131Cs, brachytherapy, metastasis, radiation, radiotherapy

 
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