The role of cesium-131 brachytherapy in brain tumors: a scoping review of the literature and ongoing clinical trials

• Published in: Journal of neuro-oncology Vol. 159; no. 1; pp. 117 - 133
• Main Authors: Palmisciano, Paolo, Haider, Ali S., Balasubramanian, Kishore, D’Amico, Randy S., Wernicke, Alla Gabriella
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2022; Springer Nature B.V
• Subjects: Brachytherapy; Brachytherapy - adverse effects; Brain cancer; Brain Neoplasms - pathology; Brain tumors; Cesium; Cesium Radioisotopes; Clinical trials; Glioma; Glioma - radiotherapy; Humans; Literature reviews; Medicine; Medicine & Public Health; Meningeal Neoplasms - surgery; Meningioma - surgery; Metastases; Metastasis; Neurology; Oncology; Patients; Radiation Injuries; Radiation therapy; Review; Seeds; Seizures; Surgical site infections; Treatment Outcome; Tumors; Wound infection; Cesium-131 brachytherapy; Neuro-oncology; Brain metastases; Glioma; Radiotherapy; Meningioma
• ISSN: 0167-594X; 1573-7373; 1573-7373
• DOI: 10.1007/s11060-022-04050-3

Purpose Cesium-131 radioactive isotope has favored the resurgence of intracavitary brachytherapy in neuro-oncology, minimizing radiation-induced complications and maximizing logistical and clinical outcomes. We reviewed the literature on cesium-131 brachytherapy for brain tumors. Methods PubMed, Web-of-Science, Scopus, Clinicaltrial.gov, and Cochrane were searched following the PRISMA extension for scoping reviews to include published studies and ongoing trials reporting cesium-131 brachytherapy for brain tumors. Results We included 27 published studies comprising 279 patients with 293 lesions, and 3 ongoing trials. Most patients had brain metastases (63.1%), followed by high-grade gliomas (23.3%), of WHO Grade III (15.2%) and Grade IV (84.8%), and meningiomas (13.6%), mostly of WHO Grade II (62.8%) and Grade III (27.9%). Most brain metastases were newly diagnosed (72.3%), while most gliomas and meningiomas were recurrent (95.4% and 88.4%). Patients underwent gross-total (91.1%) or subtotal (8.9%) resection, with median postoperative cavity size of 3.5 cm (range 1–5.8 cm). A median of 20, 28, and 16 seeds were implanted in gliomas, meningiomas, and brain metastases, with median seed activity of 3.8 mCi (range 2.4–5 mCi). Median follow-up was 16.2 months (range 0.6–72 months). 1-year freedom from progression rates were local 94% (range 57–100%), regional 85.1% (range 55.6–93.8%), and distant 53.5% (range 26.3–67.4%). Post-treatment radiation necrosis, seizure, and surgical wound infection occurred in 3.4%, 4.7%, and 4.3% patients. Conclusion Initial data suggest that cesium-131 brachytherapy is safe and effective in primary or metastatic malignant brain tumors. Ongoing trials are evaluating long-term locoregional tumor control and future studies should analyze its role in multimodal systemic tumor management.