Download PDF
Nuklearmedizin 2021; 60(04): 283-288
DOI: 10.1055/a-1429-1967
Original Article

Intracranial 131I-chTNT Brachytherapy in Patients with Deep-Seated Glioma: A Single-center Experience with 10-Year Follow-up from China

Intrakranielle 131I-chTNT-Brachytherapie bei Patienten mit tiefsitzendem Gliom: Erfahrung eines Zentrums in China mit Follow-up über 10 Jahre
Ming Zhao
  Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
,
Xiangping Fu
  Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
,
Zhiwen Zhang
  Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
,
Anmin Li
  Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
,
Xiaopeng Wang
  Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
,
Xuexiu Li
  Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective The intracranial brachytherapy has been applied for decades, however, no results with long-term follow-up have been reported. This study investigated the long-term efficiency of intra-tumoral injection of 131I-chTNT in patients with deep-seated glioma.

Method Thirty-five patients undergoing 131I-chTNT brachytherapy between December 2004 and May 2009 were enrolled. 131I-chTNT was injected at a dose of 1.5 mCi/cm3 at an interval of 1 month for consecutive 3 times. Serial ECT scan and MRI were performed during follow-up. Progression-free survival (PFS) and overall survival (OS) were analyzed. Adverse reactions were graded with WHO Toxicity Grading Scale for determining the severity of adverse events.

Results ECT scan showed that enhanced accumulation of radioactive agents in the tumor lasted for more than 30 days. Three months after final injection, tumor complete remission (CR) was observed in 4 patients (11.4 %), partial remission (PR) in 11 cases (31.4 %), stable disease (SD) in 10 cases (28.6 %) and progressive disease (PD) in 10 cases (28.6 %). At 6-month, CR, PR, SD and PD were 2, 6, 12 and 15 respectively. After 10 years of follow-up, median progression-free survival (PFS) and overall survival (OS) were 5.4 and 11.4 months. One-year survival was 45.7 %, two and five-year survival was 8.6 %, ten-year survival was 5.7 %. Multivariate analysis showed that pathological grade and tumor diameter were independent prognostic factors for PFS and OS. Grade I–II adverse events occurred after drug injection, including nausea, fever, headache, hairloss and fatigue.

Conclusion 131I-chTNT intracranial brachytherapy is efficient and safe for patients with deep-seated glioma. It is a reliable option for inoperable glioma patients.

Zusammenfassung

Ziel Die intrakranielle Brachytherapie wird seit Jahrzehnten angewandt, jedoch wurden bisher keine Ergebnisse mit Langzeit-Follow-up berichtet. Diese Studie untersuchte die langfristige Effizienz der intratumoralen Injektion von 131I-chTNT bei Patienten mit tiefsitzendem Gliom.

Methode 35 Patienten, die sich zwischen Dezember 2004 und Mai 2009 einer 131I-chTNT-Brachytherapie unterzogen, wurden eingeschlossen. 131I-chTNT wurde mit einer Dosis von 1,5mCi/cm3 in 1-monatlichem Abstand 3-mal hintereinander injiziert. Im Follow-up wurden serielle ECT-Scans und MRTs durchgeführt. Das progressionsfreie Überleben (PFS) und das Gesamtüberleben (OS) wurden analysiert. Nebenwirkungen wurden mit den WHO-Toxizitätskriterien (WHO Toxicity Grading Scale) bewertet, um ihren Schweregrad zu bestimmen.

Ergebnisse Der ECT-Scan zeigte, dass die verstärkte Anreicherung radioaktiver Substanzen im Tumor mehr als 30 Tage anhielt. Drei Monate nach der letzten Injektion wurde bei 4 Patienten (11,4 %) eine komplette Tumorremission (CR), in 11 Fällen (31,4 %) eine partielle Remission (PR), in 10 Fällen (28,6 %) eine stabile Erkrankung (SD) und in 10 Fällen (28,6 %) eine progressive Erkrankung (PD) beobachtet. Nach 6 Monaten betrug die Fallzahl 2 für CR, 6 für PR, 12 für SD und 15 für PD. Nach 10-jährigem Follow-up betrug das mediane progressionsfreie Überleben (PFS) 5,4 Monate und das Gesamtüberleben (OS) 11,4 Monate. Die 1-Jahres-Überlebensrate lag bei 45,7 %, die 2- und 5-Jahres-Überlebensrate bei 8,6 %, die 10-Jahres-Überlebensrate bei 5,7 %. Multivariate Analysen zeigten, dass der pathologische Grad und der Tumordurchmesser unabhängige prognostische Faktoren für PFS und OS waren. Nebenwirkungen vom Grad I–II traten nach der Injektion des Arzneimittels auf, einschließlich Übelkeit, Fieber, Kopfschmerzen, Haarausfall und Müdigkeit.

Schlussfolgerung Die intrakranielle Brachytherapie mit 131I-chTNT ist effizient und sicher für Patienten mit tiefsitzendem Gliom. Sie ist eine zuverlässige Option für Patienten mit inoperablem Gliom.

Key words

glioma - deep-seated - 131I-chTNT - brachytherapy - intratumoral

Schlüsselwörter

Gliom - tiefsitzend - 131I-chTNT - Brachytherapie - intratumoral


Publication History

Received: 08 December 2020

Accepted: 11 March 2021

Article published online:
09 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Armstrong TS, Dirven L, Arons D. et al. Glioma patient-reported outcome assessment in clinical care and research: a Response Assessment in Neuro-Oncology collaborative report. Lancet Oncol 2020; 21 (02) e97-e103
    CrossrefPubMedGoogle Scholar
  • 2 Akiyama Y, Wanibuchi M, Mikami T. et al. Rigid endoscopic resection of deep-seated or intraventricular brain tumors. Neurol Res 2015; 37 (03) 278-282
    CrossrefPubMedGoogle Scholar
  • 3 Ooba H, Abe T, Momii Y. et al. Stereotactic biopsy with electrical monitoring for deep-seated brain tumors. World Neurosurg 2013; 79 (01) 207.e1-207.e5
    CrossrefPubMedGoogle Scholar
  • 4 Yang SH, Hong CT, Tsai FY. et al. Anatomical relationships between medullary veins and three types of deep-seated malignant brain tumors as detected by susceptibility-weighted imaging. J Chin Med Assoc 2020; 83 (02) 164-169
    CrossrefPubMedGoogle Scholar
  • 5 Neuloh G, Simon M, Schramm J. Stroke prevention during surgery for deep-seated gliomas. Neurophysiol Clin 2007; 37 (06) 383-389
    CrossrefPubMedGoogle Scholar
  • 6 Iyer R, Chaichana KL. Minimally Invasive Resection of Deep-seated High-grade Gliomas Using Tubular Retractors and Exoscopic Visualization. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (04) 330-336
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Taal W, Bromberg JE, van den Bent MJ. Chemotherapy in glioma. CNS Oncol 2015; 4 (03) 179-192
    CrossrefPubMedGoogle Scholar
  • 8 Sachpekidis C, Jackson DB, Soldatos TG. Radioimmunotherapy in Non-Hodgkin's Lymphoma: Retrospective Adverse Event Profiling of Zevalin and Bexxar. Pharmaceuticals (Basel) 2019; 12 (04) E141
    CrossrefPubMedGoogle Scholar
  • 9 Green DJ, O'Steen S, Lin Y. et al. CD38-bispecific antibody pretargeted radioimmunotherapy for multiple myeloma and other B-cell malignancies. Blood 2018; 131 (06) 611-620
    CrossrefPubMedGoogle Scholar
  • 10 Hdeib A, Sloan A. Targeted radioimmunotherapy: the role of ¹³¹I-chTNT-1/B mAb (Cotara) for treatment of high-grade gliomas. Future Oncol 2012; 8 (06) 659-669
    CrossrefPubMedGoogle Scholar
  • 11 Yu L, Ju DW, Chen W. et al. 131I-chTNT radioimmunotherapy of 43 patients with advanced lung cancer. Cancer Biother Radiopharm 2006; 21 (01) 5-14
    CrossrefPubMedGoogle Scholar
  • 12 Zheng SG, Xu HX, Guo LH. et al. The safety and treatment response of combination therapy of radioimmunotherapy and radiofrequency ablation for solid tumor: a study in vivo. PLoS One 2014; 9 (05) e96539
    CrossrefPubMedGoogle Scholar
  • 13 Kramer K, Donzelli M, Nwora E. et al. Assessing Cerebrospinal Fluid Flow Dynamics in Pediatric Patients with Central Nervous System Tumors Treated with Intraventricular Radioimmunotherapy. J Nucl Med 2020; DOI: 10.2967/jnumed.119.232678.
    CrossrefPubMedGoogle Scholar
  • 14 Gholamrezanezhad A, Shooli H, Jokar N. et al. Radioimmunotherapy (RIT) in Brain Tumors. Nucl Med Mol Imaging 2019; 53 (06) 374-381
    CrossrefPubMedGoogle Scholar
  • 15 Loya J, Zhang C, Cox E. et al. Biological intratumoral therapy for the high-grade glioma part II: vector- and cell-based therapies and radioimmunotherapy. CNS Oncol 2019; 8 (03) CNS40
    CrossrefPubMedGoogle Scholar
  • 16 Patel SJ, Shapiro WR, Laske DW. et al Safety and feasibility of convection-enhanced delivery of Cotara for the treatment of malignant glioma: initial experience in 51 patients. Neurosurgery 2005; 56 (06) 1243-1252 ; discussion 1252-1253
    CrossrefPubMedGoogle Scholar
  • 17 Chen S, Yu L, Jiang C. et al. Pivotal study of iodine-131-labeled chimeric tumor necrosis treatment radioimmunotherapy in patients with advanced lung cancer. J Clin Oncol 2005; 23 (07) 1538-1547
    CrossrefPubMedGoogle Scholar
  • 18 Shapiro WR, Carpenter SP, Roberts K. et al. 131I-chTNT-1/B mAb: tumor necrosis therapy for malignant astrocytic glioma. Expert Opin Biol Ther 2006; 6 (05) 539-545
    CrossrefPubMedGoogle Scholar
  • 19 Chen FM, Taylor CR, Epstein AL. Tumor necrosis treatment of ME-180 human cervical carcinoma model with 131I label TNT-1 monoclonal antibody [J]. Cancer Res 1989; 49: 4578-4585
    PubMedGoogle Scholar
  • 20 Shapiro WR, Carpenter SP, Roberts K. et al. (131)I-chTNT-1/B mAb: tumour necrosis therapy for malignant astrocytic glioma. Expert Opin Biol Ther 2006; 6 (05) 539-545
    CrossrefPubMedGoogle Scholar
  • 21 Hdeib A, Sloan AE. Convection-enhanced delivery of 131I-chTNT-1/B mAB for treatment of high-grade adult gliomas. Expert Opin Biol Ther 2011; 11 (06) 799-806
    CrossrefPubMedGoogle Scholar
  • 22 Norden AD, Wen PY. Glioma therapy in adults. Neurologist 2006; 12 (06) 279-292
    CrossrefPubMedGoogle Scholar
  • 23 Julow J, Szeifert GT, Bálint K. et al. Tissue response to iodine-125 interstitial brachytherapy of cerebral gliomas. Prog Neurol Surg 2007; 20: 312-323
    CrossrefPubMedGoogle Scholar