Review of Radiosurgery of Pineal Parenchymal Tumors. Long Survival Following 125-Iodine Brachytherapy of Pineoblastomas in 2 Cases

Abstract

Objective: The aim of the present work is to report the volumetric changes of tumor in two pineoblastoma patients treated with stereotactic interstitial irradiation and to present a review on radiosurgery of pineal parenchymal tumors. Methods: Two of our patients with pineoblastoma were treated with CT and image-fusion guided 125-iodine brachytherapy. The tumor volumes were determined with outlined contours on planning and control CT/MRI images and were compared. Results: Until January 2006, there were 61- and 58-month follow-up periods in the two cases. 56 and 53 months after irradiation the MRI images showed significant tumor shrinkage. In case 1 tumor volume was 0.76 cm³ on the last control MRI image, compared to the 2.87 cm³ at the time of interstitial irradiation, which means 73% shrinkage. In case 2, tumor volume measured with the last control MRI examination was 0.29 cm³, which represents 77% shrinkage of the original tumor volume. In both Cases 1 and 2, PET examinations using ¹¹C-methionine showed no active tumor mass 56 and 53 months following brachytherapy. Conclusion: Two successful treatments of pineoblastoma are reported. The interstitial irradiation of the tumors decreased their volumes significantly. The CT and image fusion-guided 125-iodine stereotactic brachytherapy can be planned well dosimetrically and is surgically precise.

Key words

Pineoblastoma - brachytherapy - 125-iodine interstitial irradiation - shrinkage - image fusion

References

• 1 Araki C, Matsumoto S. Statistical re-evaluation of pinealoma and related tumors in Japan.  J Neurosurg. 1969;  30 146-149
• 2 Barlas O, Bayindir Ç, İmer M. et al . Non-resective management of pineoblastoma.  Minim Invas Neurosurg. 2000;  43 163-170
• 3 Edward MAB, Hudgins RJ, Wilson CB. Pineal region tumors in children.  J Neurosurg. 1988;  68 689-697
• 4 Hoffman HJ. Pineal region tumors.  Prog Exp Tumor Res. 1987;  30 281-288
• 5 Packer RJ, Sutton LN, Rosenstock JE. et al . Pineal region tumors of childhood.  Pediatrics. 1984;  74 97-101
• 6 Kersh CR, Constable CW, Eisert DR. et al . Primary central nervous system germ cell tumors.  Cancer. 1988;  61 2148-2152
• 7 Mena H, Scheithauer BW, Nakazato Y. Pineal parenchymal tmours. In: Kleihues P, Cavenee WK. Pathology and genetics of tumours of the nervous system. International Agency for Research on Cancer, Lyon 1997 pp 83-88
• 8 Rubenstein LD. Tumors of the central nervous system. Atlas of tumor pathology. Washington, DC. AFIP 1972 pp 269-284
• 9 Abay EO, Laws ER, Grado GL. et al . Pineal tumors in children and adolescents.  J Neurosurg. 1981;  55 889-895
• 10 El-Mahdi AM, Philips E, Lott S. The role of radiation therapy in pinealoma.  Radiology. 1972;  103 407-412
• 11 Hasegawa T, Kondziolka D, Hadjipanayis CG. et al . The role of radiosurgery for the treatment of pineal parenchymal tumors.  Neurosurgery. 2002;  51 880-889
• 12 Ostertag C. Pineal region management - A stereotactic perspective.  Pan Arab-Journals. 1999;  3 2-12
• 13 Regis J, Bouillot P, Rouby-Volot F. et al . Pineal region tumors and the role of stereotactic biopsy. Review of the mortality, morbidity, and diagnostic rates in 370 cases.  Neurosurgesry. 1996;  39 907-911
• 14 Dempsey PK, Kondziolka D, Lunsford LD. Stereotactic diagnosis and treatment of pineal region tumours and vascular malformations.  Acta Neurochir. 1992;  116 14-22
• 15 Dempsey PK, Lunsford LD. Stereotactic radiosurgery for pineal region tumors.  Neurosurg Clin N Am. 1992;  3 245-253
• 16 Julow J, Major T, Emri M. et al . The application of image fusion in stereotactic brachytherapy of brain tumours.  Acta Neurochir. 2000;  142 1253-1258
• 17 Viola A, Major T, Julow J. The importance of postoperative CT image fusion verification of stereotactic interstitial irradiation for brain tumors.  Int J Radiat Oncol Bilo Phys. 2004;  60 322-328
• 18 Dandy WE. Operative experiences incases of pineal tumors.  Arch Surg. 1936;  33 19-46
• 19 Jamieson KG. Excision of pineal tumors.  J Neurosurg. 1971;  35 550-553
• 20 Pendl G. The surgery of pineal lesions - historical perspective. In: Neuwelt ER (ed), Diagnosis and treatment of pineal region tumours. Williams and Wilkins, Baltimore 1984 pp 139-154
• 21 Poppen JL. The right occipital approach to a pinealoma.  J Neurosurg. 1966;  25 706-710
• 22 Rosenfeld JF. Supratentorial approaches to pineal tumors. In: Kaye AH, Black PMcL (eds), Operative neurosurgery. Harcourt Publishers Limited, London, New York, Philadelphia, St. Luis, Sydney, Toronto 2000 pp 825-840
• 23 Pecker J, Scarabin JM, Vallee B. et al . Treatment in tumours of the pineal region. Value of stereotaxic biopsy.  Surg Neurol. 1979;  12 341-348
• 24 Shibamoto Y, Abe M, Yamashita J. et al . Treatment results of intracranial germinoma as a function of the irradiated volume.  Int J Radiat Oncol Biol Phys. 1988;  15 285-290
• 25 Herrmann HD, Winkler D, Westphal M. Treatment of tumours of the pineal region and posterior part of the third ventricle.  Acta Neurochir. 1992;  116 137-146
• 26 Kreth FW, Schatz CR, Pagenstecher A. et al . Stereotactic management of lesions of the pineal region.  Neurosurgery. 1996;  39 280-291
• 27 Backlund EO, Rähn T, Sarby B. Treatment of pinealomas by stereotaxic radiation surgery.  Acta Radiol Ther Phys Biol. 1974;  13 368-376
• 28 Borit A, Blackwood W, Mair WGP. The separation of pineocytoma from pineoblastoma.  Cancer. 1980;  45 1408-1418
• 29 Buatti JM, Bova FJ, Friedman WA. et al . Preliminary experience with frameless stereotactic radiotherapy.  Int J Radiat Oncol Biol Phys. 1998;  42 591-599
• 30 Casentini L, Colombo F, Pozza F. et al . Combined radiosurgery and external radiotherapy of intracranial germinomas.  Surg Neurol. 1990;  34 79-86
• 31 Regine WF, Hodes JE, Patchell RA. Intracranial germinoma. Treatment with radiosurgery alone.  J Neurooncol. 1998;  37 75-77
• 32 Wara WM, Jenkin RDT, Evans A. et al . Tumors of the pineal and suprasellar region. Children's Cancer Study Group treatment results 1960-1975.  Cancer. 1979;  43 698-701
• 33 Zeng-min T, Zong-hui L, Gui-quan K. et al . CT-guided stereotactic injection of radionuclide for treatment of brain tumors.  Stereotact Funct Neurosurg. 1992;  59 169-173
• 34 Chao CKS, Lee STL, Lin FJ. et al . A multivariate analysis of prognostic factors in management of pineal tumor.  Int J Radiat Oncol Biol Phys. 1993;  27 1185-1191
• 35 Fuller BG, Kapp DS, Cox R. Radiation therapy of pineal region tumors. 25 new cases and a review of 208 previously reported cases.  Int J Radiat Oncol Biol Phys. 1994;  28 229-245
• 36 Chapman PH, Linggood RM. The management of pineal area tumors. A recent reappraisal.  Cancer. 1980;  46 1253-1257
• 37 D’Andrea AD, Packer RJ, Rorke LB. et al . Pineocytomas of childhood. A reappraisal of natural history and response to therapy.  Cancer. 1987;  59 1353-1357
• 38 Frank F, Gaist G, Piazza G. et al . Stereotaxic biopsy and radioactive implantation for interstitial therapy of tumors of the pineal region.  Surg Neurol. 1985;  23 275-280
• 39 Linggood RM, Chapman PH. Pineal tumors.  J Neuro-Oncol. 1992;  12 85-91
• 40 Manera L, Régis J, Chinot O. et al . Pineal region tumors. The role of stereotactic radiosurgery.  Stereotact Funct Neurosurg. 1996;  66 164-173
• 41 Matsumoto K, Higashi H, Tomita S. et al . Pineal region tumours treated with interstitial brachytherapy with low activity sources (192-iridium).  Acta Neurochir. 1995;  136 21-28
• 42 Neuwelt EA, Glasberg M, Frenkel E. et al . Malignant pineal region tumors. A clinico-pathological study.  J Neurosurg. 1979;  51 597-607
• 43 Stein BM. The infratentorial supracerebellar approach to pineal lesions.  J Neurosurg. 1971;  35 197-202
• 44 Sung DII, Harisiadis L, Chang CH. Midline pineal tumors and suprasellar germinomas. Highly curable by irradiation.  Radiology. 1978;  128 745-751
• 45 Van Wagenen WP. A surgical approach for the removal of certain pineal tumors. Report of a case.  Surg Gynecol Obstet. 1931;  53 216-220
• 46 Schild SE, Scheithauer BW, Schomberg PJ. et al . Pineal parenchymal tumours.  Cancer. 1993;  72 870-879
• 47 Bradfield JS, Perez CA. Pineal tumors and ectopic pinealomas.  Radiology. 1972;  103 399-406
• 48 Rao YTR, Medini E, Haselow RE. et al . Pineal and ectopic pineal tumors. The role of radiation therapy.  Cancer. 1981;  48 708-713
• 49 Mincer F, Meltzer J, Botstein C. Pinealoma. A report of twelve irradiated cases.  Cancer. 1976;  37 2713-2718

Correspondence