Smruti Mahapatra, Laurel Seltzer, Neydin Osorio, Michelle Miller, Andrew Janssen, Raj Mitra, Joseph Keen, Clayton Smith, Marcus Ware
{"title":"微创锁眼开颅和立体定向近距离治疗新发脑少转移瘤的前瞻性研究。","authors":"Smruti Mahapatra, Laurel Seltzer, Neydin Osorio, Michelle Miller, Andrew Janssen, Raj Mitra, Joseph Keen, Clayton Smith, Marcus Ware","doi":"10.1007/s11060-025-05077-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Metastatic brain tumors (MBTs) are the most common intracranial tumors, affecting up to 40% of cancer patients. Traditional treatments such as Whole Brain Radiotherapy (WBRT) and Stereotactic Radiosurgery (SRS) have limitations, including neurocognitive decline and potential tumor regrowth. Minimally invasive keyhole craniotomy (MIKC) and Cesium-131 (Cs-131) brachytherapy offer promising alternatives due to their precision and reduced side effects. This prospective study aims to evaluate the safety and efficacy of combining MIKC with Cs-131 brachytherapy in treating newly diagnosed brain oligometastases.</p><p><strong>Methods: </strong>Twenty-one adults with newly diagnosed brain metastases were enrolled from 2019 to 2021. Preoperative T1 MRI with gadolinium was used to calculate the gross tumor volume (GTV). Minimally invasive craniotomies were performed with resection of these tumors, followed by the implantation of Cs-131 seeds. Postoperative imaging was conducted to verify seed placement and resection. Dosimetric values (V100, V200, D90) were calculated. Patients were followed every two months for two years to monitor local progression, functional outcomes, and quality of life. The primary endpoint was freedom from local progression, with secondary endpoints including overall survival, functional outcomes, quality of life, and treatment-related complications.</p><p><strong>Results: </strong>The median preoperative tumor volume was 10.65 cm<sup>3</sup>, reducing to a resection cavity volume of 6.05 cm<sup>3</sup> post-operatively. Dosimetric analysis showed a median V100 coverage of 93.2%, V200 of 43.9%, and D90 of 89.8 Gy. The 1-year local freedom from progression (FFP) was 91.67%, while the distant FFP was 53.91%. Five patients remained alive at the study's end, with a median survival duration of 5.9 months, a duration likely impacted by the concurrent COVID-19 pandemic. Only one patient experienced local recurrence, and no cases of radiation necrosis were observed. Significant improvements were seen in neurological, functional, and cognitive symptoms.</p><p><strong>Conclusion: </strong>Combining MIKC with Cs-131 brachytherapy is effective for local tumor control and improving functional outcomes in patients with brain oligometastases. Further studies with larger cohorts are needed to validate these findings and refine treatment protocols.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1051-1064"},"PeriodicalIF":3.1000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511137/pdf/","citationCount":"0","resultStr":"{\"title\":\"A prospective study of minimally invasive keyhole craniotomy and stereotactic brachytherapy for new brain oligometastases.\",\"authors\":\"Smruti Mahapatra, Laurel Seltzer, Neydin Osorio, Michelle Miller, Andrew Janssen, Raj Mitra, Joseph Keen, Clayton Smith, Marcus Ware\",\"doi\":\"10.1007/s11060-025-05077-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Metastatic brain tumors (MBTs) are the most common intracranial tumors, affecting up to 40% of cancer patients. Traditional treatments such as Whole Brain Radiotherapy (WBRT) and Stereotactic Radiosurgery (SRS) have limitations, including neurocognitive decline and potential tumor regrowth. Minimally invasive keyhole craniotomy (MIKC) and Cesium-131 (Cs-131) brachytherapy offer promising alternatives due to their precision and reduced side effects. This prospective study aims to evaluate the safety and efficacy of combining MIKC with Cs-131 brachytherapy in treating newly diagnosed brain oligometastases.</p><p><strong>Methods: </strong>Twenty-one adults with newly diagnosed brain metastases were enrolled from 2019 to 2021. Preoperative T1 MRI with gadolinium was used to calculate the gross tumor volume (GTV). Minimally invasive craniotomies were performed with resection of these tumors, followed by the implantation of Cs-131 seeds. Postoperative imaging was conducted to verify seed placement and resection. Dosimetric values (V100, V200, D90) were calculated. Patients were followed every two months for two years to monitor local progression, functional outcomes, and quality of life. The primary endpoint was freedom from local progression, with secondary endpoints including overall survival, functional outcomes, quality of life, and treatment-related complications.</p><p><strong>Results: </strong>The median preoperative tumor volume was 10.65 cm<sup>3</sup>, reducing to a resection cavity volume of 6.05 cm<sup>3</sup> post-operatively. Dosimetric analysis showed a median V100 coverage of 93.2%, V200 of 43.9%, and D90 of 89.8 Gy. The 1-year local freedom from progression (FFP) was 91.67%, while the distant FFP was 53.91%. Five patients remained alive at the study's end, with a median survival duration of 5.9 months, a duration likely impacted by the concurrent COVID-19 pandemic. Only one patient experienced local recurrence, and no cases of radiation necrosis were observed. Significant improvements were seen in neurological, functional, and cognitive symptoms.</p><p><strong>Conclusion: </strong>Combining MIKC with Cs-131 brachytherapy is effective for local tumor control and improving functional outcomes in patients with brain oligometastases. Further studies with larger cohorts are needed to validate these findings and refine treatment protocols.</p>\",\"PeriodicalId\":16425,\"journal\":{\"name\":\"Journal of Neuro-Oncology\",\"volume\":\" \",\"pages\":\"1051-1064\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511137/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuro-Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11060-025-05077-y\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuro-Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11060-025-05077-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
A prospective study of minimally invasive keyhole craniotomy and stereotactic brachytherapy for new brain oligometastases.
Introduction: Metastatic brain tumors (MBTs) are the most common intracranial tumors, affecting up to 40% of cancer patients. Traditional treatments such as Whole Brain Radiotherapy (WBRT) and Stereotactic Radiosurgery (SRS) have limitations, including neurocognitive decline and potential tumor regrowth. Minimally invasive keyhole craniotomy (MIKC) and Cesium-131 (Cs-131) brachytherapy offer promising alternatives due to their precision and reduced side effects. This prospective study aims to evaluate the safety and efficacy of combining MIKC with Cs-131 brachytherapy in treating newly diagnosed brain oligometastases.
Methods: Twenty-one adults with newly diagnosed brain metastases were enrolled from 2019 to 2021. Preoperative T1 MRI with gadolinium was used to calculate the gross tumor volume (GTV). Minimally invasive craniotomies were performed with resection of these tumors, followed by the implantation of Cs-131 seeds. Postoperative imaging was conducted to verify seed placement and resection. Dosimetric values (V100, V200, D90) were calculated. Patients were followed every two months for two years to monitor local progression, functional outcomes, and quality of life. The primary endpoint was freedom from local progression, with secondary endpoints including overall survival, functional outcomes, quality of life, and treatment-related complications.
Results: The median preoperative tumor volume was 10.65 cm3, reducing to a resection cavity volume of 6.05 cm3 post-operatively. Dosimetric analysis showed a median V100 coverage of 93.2%, V200 of 43.9%, and D90 of 89.8 Gy. The 1-year local freedom from progression (FFP) was 91.67%, while the distant FFP was 53.91%. Five patients remained alive at the study's end, with a median survival duration of 5.9 months, a duration likely impacted by the concurrent COVID-19 pandemic. Only one patient experienced local recurrence, and no cases of radiation necrosis were observed. Significant improvements were seen in neurological, functional, and cognitive symptoms.
Conclusion: Combining MIKC with Cs-131 brachytherapy is effective for local tumor control and improving functional outcomes in patients with brain oligometastases. Further studies with larger cohorts are needed to validate these findings and refine treatment protocols.
期刊介绍:
The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.