Format

Send to

Choose Destination
J Neurosurg Sci. 2018 Apr;62(2):214-220. doi: 10.23736/S0390-5616.16.03547-X. Epub 2016 Jan 15.

Combined stereotactic biopsy and stepping-source interstitial irradiation of glioblastoma multiforme.

Author information

1
Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
2
Experimental Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
3
Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
4
Carl Zeiss Meditec AG, Oberkochen, Germany.
5
Department of Orthopedic and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
6
Medical Radiation Physics/Radiation Protection, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
7
Department of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
8
Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany - frank.giordano@umm.de.

Abstract

Patients diagnosed with glioblastoma multiforme receiving stereotactic biopsy only either due to tumor localization or impaired clinical status face a devastating prognosis with very short survival times. One strategy to provide an initial cytoreductive and palliative therapy at the time of the stereotactic biopsy is interstitial irradiation through the pre-defined trajectory of the biopsy channel. We designed a novel treatment planning system and evaluated the treatment potential of a fixed-source and a stepping-source algorithm for interstitial radiosurgery on non-spherical glioblastoma in direct adjacency to risk structures. Using both setups, we show that radiation doses delivered to 100% of the gross tumor volume shifts from sub-therapeutic (10-12 Gy) to sterilizing single doses (25-30 Gy) when using the stepping source algorithm due to improved sparing of organs-at-risk. Specifically, the maximum doses at the brain stem were 100% of the PTV dose when a fixed central source and 38% when a stepping-source algorithm was used. We also demonstrated precision of intracranial target points and stability of superficial and deep trajectories using both a phantom and a body donor study. Our setup now for the first time provides a basis for a clinical proof-of-concept trial and may widen palliation options for patients with limited life expectancy that should not undergo time-consuming therapies.

PMID:
26771176
DOI:
10.23736/S0390-5616.16.03547-X
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Minerva Medica
Loading ...
Support Center