PDF herunterladen
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(04): e288-e294
DOI: 10.1055/s-0041-1733864
Original Article

Stereotactic Intracavitary Irradiation for Cystic Craniopharyngiomas with Rhenium-186

Irradiação estereotáxica intracavitária para craniofaringiomas císticos com Rênio 186
Walter Fagundes 
1   Department of Neurosurgery, Roger Salengro Hospital Center, Lille University, Lille, France
3   Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
,
Rodolpho Albuquerque Souza
3   Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
,
Gustavo Touzet
1   Department of Neurosurgery, Roger Salengro Hospital Center, Lille University, Lille, France
,
Philippe Carpentier
2   Department of Nuclear Medicine, Oscar Lambret Center, Lille, France
,
Patrick Dhellemmes
1   Department of Neurosurgery, Roger Salengro Hospital Center, Lille University, Lille, France
,
Serge Blond
1   Department of Neurosurgery, Roger Salengro Hospital Center, Lille University, Lille, France
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
  Lizenzen und Reprints

Abstract

Objective The intracavitary irradiation of cystic tumors has been used as a therapeutic alternative modality in the management of cystic craniopharyngiomas. In the present study, we review our experience, considering the technical issues, outcomes, and complications associated with the use of stereotactic intracavitary irradiation (SICI) with colloidal rhenium-186 (186Re) for cystic craniopharyngioma.

Material and Methods The records of 33 patients with cystic craniopharyngiomas treated by SICI with colloidal 186Re were retrospectively reviewed. The median radiation dose to the cyst wall was of 408 Gy (range: 175 Gy to 500 Gy). All tumors were composed of a large cyst cavity, and 9 (27.3%) also had a solid component. The mean follow-up period was of 3.7 years.

Results After SICI, 31 (93.9%) patients showed radiological evidence of cyst regression, and, in 2 (6.1%), no response was observed. An improvement in the visual deficits was observed in 8 cases (24.2%), and an improvement in endocrinogical disturbances, in 2 cases (6.1%). We observed complications in 3 patients (9.1%): diabetes insupidus in 1 case (3%), aggravation of visual acuity in 1 case (3%), and severe headache after infusion of the colloid in 1 case (3%); and 1 patient (3%) died after meningitis.

Conclusion Stereotactic intracavitary irradiation with colloidal 186Re is a safe procedure, with satisfactory results in the present series, and should be considered, in the management of cystic craniopharyngiomas, the first-intention therapy or as an adjuvant to other therapeutical modalities, with acceptable morbidity and mortality rates.

Resumo

Objetivo A irradiação intracavitária tem sido empregada como modalidade terapêutica alternativa no manejo dos craniofaringiomas císticos. No presente estudo, revisamos nossa experiência, considerando parâmetros técnicos, resultados e complicações associadas ao uso da irradiação estereotáxica intracavitária (IEIC) com rênio-186 (186Re) coloidal em pacientes com craniofaringiomas císticos.

Material e Métodos Os prontuários de 33 pacientes com craniofaringiomas císticos tratados por IEIC com 186Re coloidal foram revisados retrospectivamente. A dose média de radiação na parede do cisto foi de 408 Gy (variação: 175 Gy a 500 Gy). Todos os tumores eram compostos por uma grande porção cística, e, em 9 casos (27,3%) havia também um componente sólido. O período médio de seguimento foi de 3,7 anos.

Resultados Após a IEIC, 31 (93,9%) pacientes apresentaram evidência radiológica de regressão do cisto, e em 2 (6,1%) não foi observada resposta. Melhora do déficit visual foi observada em 8 casos (24,2%), e dos distúrbios endocrinológicos, em 2 casos (6,1%). Complicações ocorreram em 3 pacientes (9,1%): diabetes insipidus em 1 caso (3%), piora da acuidade visual em 1 caso (3%), e cefaleia intensa após a infusão do coloide em 1 caso (3%); e 1 paciente (3%) faleceu após meningite.

Conclusão A IEIC com 186Re coloidal é um procedimento seguro, com resultados satisfatórios nesta série, e deve ser considerada no manejo de craniofaringiomas císticos, seja como intervenção primária, seja como adjuvante a outras modalidades terapêuticas, com taxas de morbidade e mortalidade aceitáveis.

Keywords

craniopharyngioma - rhenium - stereotactic techniques - stereotactic radiation therapy

Palavras-chave

craniofaringioma - rênio - técnicas estereotáxicas - radiocirurgia estereotáxica


Publikationsverlauf

Eingereicht: 10. Juni 2020

Angenommen: 09. März 2021

Artikel online veröffentlicht:
18. Oktober 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Shahzadi S, Sharifi G, Andalibi R, Zali A, Ali-Asgari A. Management of cystic craniopharyngiomas with intracavitary irradiation with 32P. Arch Iran Med 2008; 11 (01) 30-34
    PubMedSuche in Google Scholar
  • 2 Furtado AD, Panigrahy A, Fitz CR. Handbook of Clinical Neurology; Chapter 59 - CNS and spinal tumors. Joseph C, Masdeu RGG. , editor: Elsevier; 2016
    Suche in Google Scholar
  • 3 Enriquez-Marulanda A, Sierra-Ruiz M, Pabón LM, Lobato-Polo J. Intracavitary Irradiation as a Safe Alternative for Cystic Craniopharyngiomas: Case Report and Review of the Literature. Case Rep Med 2016; ; 5 pgs, 2016: 3601395
    CrossrefPubMedSuche in Google Scholar
  • 4 Voges J, Sturm V, Lehrke R, Treuer H, Gauss C, Berthold F. Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources. Neurosurgery 1997; 40 (02) 263-269 , discussion 269–270
    CrossrefPubMedSuche in Google Scholar
  • 5 Kickingereder P, Maarouf M, El Majdoub F. et al. Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients. J Neurooncol 2012; 109 (02) 365-374
    CrossrefPubMedSuche in Google Scholar
  • 6 Maarouf M, El Majdoub F, Fuetsch M. et al. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children. Strahlenther Onkol 2016; 192 (03) 157-165
    CrossrefPubMedSuche in Google Scholar
  • 7 Zhao R, Deng J, Liang X, Zeng J, Chen X, Wang J. Treatment of cystic craniopharyngioma with phosphorus-32 intracavitary irradiation. Childs Nerv Syst 2010; 26 (05) 669-674
    CrossrefPubMedSuche in Google Scholar
  • 8 Leksell L, Liden K. A therapeutic trial with radioactive isotopes in cystic brain tumor. In: Establishment AER. , editor. Radioisotope Techniques: Medical and physiological applications: H.M. Stationery Office. 1951
    Suche in Google Scholar
  • 9 Backlund EO. Colloidal radioisotopes as part of a multi-modality treatment of craniopharyngiomas. J Neurosurg Sci 1989; 33 (01) 95-97
    PubMedSuche in Google Scholar
  • 10 Szikla G, Musolino A, Miyahara S, Schaub C, Askienazy S. Colloidal Rhenium-186 in endocavitary beta irradiation of cyst craniopharyngiomas and active glioma cysts. Long term results, side effects and clinical dosimetry. Acta Neurochir (Wien) 1984; 33: 1-339
    PubMedSuche in Google Scholar
  • 11 Vanhauwaert D, Hallaert G, Baert E, Van Roost D, Okito JP, Caemaert J. Treatment of cystic craniopharyngioma by endocavitary instillation of yttrium90 radioisotope–still a valuable treatment option. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (05) 307-312
    Thieme ConnectPubMedSuche in Google Scholar
  • 12 Netzeband G, Sturm V, Georgi P. et al, Eds. Results of Stereotactic Intracavitary Irradiation of Cystic Craniopharyngiomas. Comparison of the Effects of Yttrium-90 and Rhenium-1861984;. Vienna: Springer Vienna;
  • 13 Pollack IF, Lunsford LD, Slamovits TL, Gumerman LW, Levine G, Robinson AG. Stereotaxic intracavitary irradiation for cystic craniopharyngiomas. J Neurosurg 1988; 68 (02) 227-233
    CrossrefPubMedSuche in Google Scholar
  • 14 Szeifert GT, Bálint K, Sipos L, Sarker MH, Czirják S, Julow J. Pathological findings in cystic craniopharyngiomas after stereotactic intracavitary irradiation with yttrium-90 isotope. Prog Neurol Surg 2007; 20: 297-302
    CrossrefPubMedSuche in Google Scholar
  • 15 Szeifert GT, Julow J, Slowik F, Bálint K, Lányi F, Pásztor E. Pathological changes in cystic craniopharyngiomas following intracavital 90yttrium treatment. Acta Neurochir (Wien) 1990; 102 (1-2): 14-18
    CrossrefPubMedSuche in Google Scholar
  • 16 Szeifert GT, Julow J, Szabolcs M, Slowik F, Bálint K, Pásztor E. Secretory component of cystic craniopharyngiomas: a mucino-histochemical and electron-microscopic study. Surg Neurol 1991; 36 (04) 286-293
    CrossrefPubMedSuche in Google Scholar
  • 17 Berenger N, Lebtahi R, Piketty M. et al. Traitement endocavitaire par le rhénium 186 des kystes de crâniopharyngiomes. Med Nucl (Paris) 1993; •••: 120-128
    PubMedSuche in Google Scholar
  • 18 Julow J, Lanyi F, Hajda M. et al. Treatment of cystic craniopharyngiomas with yttrium-90 colloid solution. Neurosurg Focus 1997; 3 (06) e6
    CrossrefPubMedSuche in Google Scholar
  • 19 Julow J, Lányi F, Hajda M. et al. Stereotactic intracavitary irradiation of cystic craniopharyngiomas with yttrium-90 isotope. Prog Neurol Surg 2007; 20: 289-296
    CrossrefPubMedSuche in Google Scholar
  • 20 Musolino A, Munari C, Blond S. et al. [Stereotaxic treatment of expanding cysts in craniopharyngiomas by endocavitary beta-irradiation (Re-186; Au-198; Y-90)]. Neurochirurgie 1985; 31 (03) 169-178
    PubMedSuche in Google Scholar
  • 21 Sturm V, Rommel T, Strauss L. Preliminary results of intracavitary irradiation of cystic craniopharyngioma by means of stereotactically applied 90 yttrium. Adv Tech Stand Neurosurg 1981; •••: 401-404
    PubMedSuche in Google Scholar
  • 22 Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 1999; 90 (02) 237-250
    CrossrefPubMedSuche in Google Scholar
  • 23 Gildenberg PL, Woo SY. Multimodality program involving stereotactic surgery in brain tumor management. Stereotact Funct Neurosurg 2000; 75 (2-3): 147-152
    CrossrefPubMedSuche in Google Scholar
  • 24 Hasegawa T, Kondziolka D, Hadjipanayis CG, Lunsford LD. Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 2004; 54 (04) 813-820 , discussion 820–822
    CrossrefPubMedSuche in Google Scholar
  • 25 Karavitaki N, Brufani C, Warner JT. et al. Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol (Oxf) 2005; 62 (04) 397-409
    CrossrefPubMedSuche in Google Scholar
  • 26 Wen PY, Huse JT. 2016 World Health Organization Classification of Central Nervous System Tumors. Continuum (Minneap Minn) 2017; 23 (6, Neuro-oncology): 1531-1547
    PubMedSuche in Google Scholar
  • 27 Kobayashi T, Kageyama N, Ohara K. Internal irradiation for cystic craniopharyngioma. J Neurosurg 1981; 55 (06) 896-903
    CrossrefPubMedSuche in Google Scholar
  • 28 Nicolato A, Foroni R, Rosta L, Gerosa M, Bricolo A. Multimodality stereotactic approach to the treatment of cystic craniopharyngiomas. Minim Invasive Neurosurg 2004; 47 (01) 32-40
    Thieme ConnectPubMedSuche in Google Scholar
  • 29 Proust F, Coche-Dequeant B, Carpentier P. et al. [Combination treatment for pilocytic astrocytoma: stereotaxic radiosurgery and endocavitary radiotherapy]. Neurochirurgie 1998; 44 (01) 50-54
    PubMedSuche in Google Scholar
  • 30 Van den Berge JH, Blaauw G, Breeman WA, Rahmy A, Wijngaarde R. Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg 1992; 77 (04) 545-550
    CrossrefPubMedSuche in Google Scholar