Budnick Hailey C, Richardson Angela M, Shiue Kevin, Watson Gordon, Ng Sook K, Le Yi, Shah Mitesh V
Neurological Surgery, Indiana University Health, Indianapolis, USA.
Radiation Oncology, Indiana University (IU) Health Simon Cancer Center, Indianapolis, USA.
Cureus. 2021 Nov 9;13(11):e19390. doi: 10.7759/cureus.19390. eCollection 2021 Nov.
GammaTile® (GT Medical Technologies, Tempe, Arizona) is a surgically targeted radiation source, approved by FDA for brachytherapy in primary and secondary brain neoplasms. Each GammaTile is composed of a collagen sponge with four seeds of cesium 131 and is particularly useful in recurrent tumors. We report our early experience in seven patients with recurrent gliomas to assess this type of brachytherapy with particular attention to ease of use, complication, and surgical planning. This study represents a retrospective chart review of surgical use and early clinical outcomes of GammaTile in recurrent gliomas. The number of tiles was planned using pre-operative imaging and dosimetry was planned based on post-operative imaging. Patients were followed during their hospital stay and were followed up after discharge. Parameters such as case length, resection extent, complication, ICU length of stay (LOS), hospital LOS, pre-operative Glasgow Coma Scale (GCS), immediate post-operative GCS, post-operative imaging findings, recurrence at follow-up, length of follow-up, and dosimetry were collected in a retrospective manner. Seven patients were identified that met the inclusion criteria. Two patients were diagnosed with recurrent glioblastoma multiforme (GBM), one lower-grade glioma that recurred as a GBM, one GBM that recurred as a gliosarcoma, and two recurrent oligodendrogliomas. We found that operation time, ICU LOS, hospital LOS, pre- and post-operative GCS, and post-operative complications were within the expected ranges for tumor resection patients. Further, dosimetry data suggests that six out of seven patients received adequate radiation coverage, with the seventh having implantation limitations due to nearby organs at risk. We report no postoperative complications that can be attributed to the GammaTiles themselves. In our cohort, we report seven cases where GammaTiles were implanted in recurrent gliomas. No implant-related post-operative complications were identified. This early data suggests that GammaTile can be a safe form of brachytherapy in recurrent gliomas.
伽马贴（GammaTile®，GT医疗技术公司，亚利桑那州坦佩）是一种手术靶向放射源，已获美国食品药品监督管理局（FDA）批准用于原发性和继发性脑肿瘤的近距离放射治疗。每片伽马贴由一块含有四颗铯131种子源的胶原海绵组成，对复发性肿瘤尤为有用。我们报告了对7例复发性胶质瘤患者的早期经验，以评估这种近距离放射治疗方式，特别关注其易用性、并发症和手术规划。本研究是对伽马贴在复发性胶质瘤手术中的应用及早期临床结果的回顾性病历审查。根据术前影像规划贴片数量，并根据术后影像规划剂量测定。患者在住院期间接受随访，并在出院后进行跟踪。以回顾性方式收集病例时长、切除范围、并发症、重症监护病房（ICU）住院时长、住院总时长、术前格拉斯哥昏迷量表（GCS）评分、术后即刻GCS评分、术后影像检查结果、随访时复发情况、随访时长和剂量测定等参数。确定有7例患者符合纳入标准。其中2例被诊断为多形性胶质母细胞瘤（GBM）复发，1例低级别胶质瘤复发为GBM，1例GBM复发为胶质肉瘤，还有2例为复发性少突胶质细胞瘤。我们发现手术时间、ICU住院时长、住院总时长、术前和术后GCS评分以及术后并发症均在肿瘤切除患者的预期范围内。此外，剂量测定数据表明，7例患者中有6例获得了足够的放射覆盖，第7例因附近存在危险器官而植入受限。我们报告没有可归因于伽马贴本身的术后并发症。在我们的队列中，我们报告了7例在复发性胶质瘤中植入伽马贴的病例。未发现与植入相关的术后并发症。这些早期数据表明，伽马贴在复发性胶质瘤中可以是一种安全的近距离放射治疗形式。
