Technique and preliminary results of interstitial irradiation for recurrent glial tumors

  • Michael Salcman
  • Wilfred Sewchand
  • Pradip P. Amin
  • Edwin H. Bellis


We have conducted a phase-I clinical trial of CT-guided stereotactic implantation of Ir192 in the treatment of malignant astrocytomas. During the past year, 16 patients have been implanted with two to four catheters in the residual enchancing portion of their tumor. These patients represent 50% of our total experience with the CT compatible Leksell frame. Each catheter contains three to six high intensity (2.0 to 2.5 mg Ra equivalent) seeds with 0.5 cm separation between the sources. The total activity of Ir192 per implant has been 30–65 mg radium equivalent. In the 16 patients, 49 catheters have been placed, an average of three targets calculated per patient and no targets have been missed. The radiation exposure to personnel has been surveyed in detail and drops off to less than 2mr/hr six feet from the patient when our custom-built radiation shield is employed. We have reserved permanent implantation of I125 for patients with tumors in unusual locations (e.g., pineal) or for individuals with slowly growing nongliomatous lesions (i.e., meningioma). The tumor volumes have ranged from 12–120 cm3. Unique aspects of our implant procedure include the use of a Leksell frame already adapted to the GE-8800 scanner, the use of pre- and post-implant computerized treatment planning programs to determine the dose distribution profiles and the use of adjustable metal collars crimped to the outer catheters to provide ease of insertion, uniform pre-implant catheter length, and protection against source migration. Two of our patients have suffered from subacute radiation reactions, primarily due to delayed cerebral edema and both of these cases have largely resolved. We believe that it is technologically feasible to deliver 5000 rads to the tumor periphery in 50 hours without undue patient toxicity or environmental radiation hazard. The system we have been studying is fully compatible with the simultaneous use of mechanical cytoreduction, chemotherapy and interstitial hyperthermia.

Key words

malignant astrocytoma glioblastoma multiforme interstitial irradiation interstitial hyperthermia radiation therapy stereotactic surgery computerized tomography 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Apuzzo MLJ, Sabshin JK: Computed tomographic guidance Stereotaxis in the management of intracranial mass lesions. Neurosurgery 12: 277–85, 1983PubMedCrossRefGoogle Scholar
  2. 2.
    Bernstein M, Gutin PH: Interstitial irradiation of brain tumors: a review. Neurosurgery 9: 741–50, 1981PubMedCrossRefGoogle Scholar
  3. 3.
    Bigner DD: Biology of gliomas: potential clinical implications of glioma cellular heterogeneity. Neurosurgery 9: 320–26, 1981PubMedCrossRefGoogle Scholar
  4. 4.
    Gutin PH, Dormandy RH: A coaxial catheter system for after-loading radioactive sources for the interstitial irradiation of brain tumors. J Neurosurg 56: 734–35, 1982PubMedCrossRefGoogle Scholar
  5. 5.
    Gutin PH, Phillips TL, Wara WM, Leibel SA, Hosobuchi Y, Levin VA, Weaver RA, Lamb S: Brachytherapy of recurrent malignant brain tumors with removeable high activity iodine-125 sources. J Neurosurg 60: 61–68, 1984PubMedCrossRefGoogle Scholar
  6. 6.
    Hosobuchi Y, Phillips TL, Stupar TA, Gutin PH: Interstitial brachytherapy of primary brain tumors. Preliminary report. J Neurosurg 53: 613–17, 1980CrossRefGoogle Scholar
  7. 7.
    Kelly PJ, Olson MH, Wright AE: Stereotactic implantation of iridium192 into CNS neoplasms. Surg Neurol 10: 349–54, 1978PubMedGoogle Scholar
  8. 8.
    Lunsford LD, Latchaw RE, Vries JK: Stereotactic implantation of deep brain electrodes using computed tomography. Neurosurgery 13: 280–86, 1983PubMedCrossRefGoogle Scholar
  9. 9.
    Mundinger F: The treatment of brain tumors with radioisotopes. Progr Neurol Surg 1: 202–257, 1966Google Scholar
  10. 10.
    Mundinger F: Rationale and methods of interstitial iridium-192-brachy-Curie therapy and iridium-192 or iodine-125 protracted long-term irradiation, in Szikla G (ed): Stereotactic cerebral irradiation, Amsterdam, Elsevier, 1979, pp 101–115Google Scholar
  11. 11.
    Ostertag CB, Hossmann KA, v d Kerckhoff W: Radiation effects of iridium-192 implants in the cat brain. Nucl Med 21: 99–104, 1982Google Scholar
  12. 12.
    Ostertag CB, Weigel K, Warnke P, Lombeck G, Kleihues P: Sequential morphologic changes in the dog brain afterinterstitial iodine-125 irradiation. Neurosurgery 13: 523–28, 1983PubMedCrossRefGoogle Scholar
  13. 13.
    Salcman M: Survival in glioblastoma — historical perspective. Neurosurgery 7: 435–39, 1980PubMedCrossRefGoogle Scholar
  14. 14.
    Salcman M, Kaplan RS, Samaras GM, Ducker TB, Broadwell RD: Aggressive multimodality therapy based on a multicompartmental model of glioblastoma. Surgery 92: 250–59, 1982PubMedGoogle Scholar
  15. 15.
    Salcman M, Samaras GM: Interstitial microwave hyperthermia for brain tumors: results of a phase-I clinical trial. J Neuro-Oncology 1: 221–36, 1983CrossRefGoogle Scholar
  16. 16.
    Sewchand W, Amin P, Salcman M, Drzymala RE, Samaras GM, Salazar OM, Botero E: Removable high intensity iridium-192 brain implants: technique and in vivo measurements in canine brain. J Neuro-Oncology 2: 177–186, 1984CrossRefGoogle Scholar
  17. 17.
    Talairich J, Ruggiero G, Aboulker J, David M: A new method of treatment of inoperable brain tumors by stereotaxic implantation of radio-active gold — a preliminary report. Br J Radiol 28: 62–74, 1955CrossRefGoogle Scholar

Copyright information

© Martinas Nijhoff Publishers, Boston 1986

Authors and Affiliations

  • Michael Salcman
    • 1
  • Wilfred Sewchand
    • 1
  • Pradip P. Amin
    • 1
  • Edwin H. Bellis
    • 1
  1. 1.The Neuro-Oncology Service, Division of Neurological Surgery and the Department of Radiation OncologyUniversity of MarylandBaltimoreUSA

Personalised recommendations