Gutin P H, Leibel S A, Hosobuchi Y, Crumley R L, Edwards M S, Wilson C B, Lamb S, Weaver K A
Neurosurgery. 1987 Jun;20(6):938-45. doi: 10.1227/00006123-198706000-00020.
Thirteen patients with recurrent, previously irradiated tumors of the skull base or spine were reirradiated with 125I sources implanted interstitially using microsurgical or stereotactic techniques. Patients harbored difficult, end-stage recurrences of chordoma, meningioma, malignant meningioma, fibrosarcoma, invasive pituitary adenoma, and malignant schwannoma. In two other patients with malignant meningioma, the dose of external radiation was augmented by implanting 125I sources during the initial operation for excision of the lesion or at a separate surgical procedure after conventional teletherapy. Microsurgical implantation of 125I sources into basal tumors was limited by the difficulties inherent in operating in this region; it is not possible to visualize the entire tumor that requires implantation. Three of five chordomas stabilized or regressed; these patients probably benefited from the procedure. Two patients with recurrent malignant meningiomas had long term remission after interstitial brachytherapy. Interstitial 125I brachytherapy for recurrent tumors at the base of skull or adjacent to the spine can be more successful only if more aggressive surgical exposures of these regions are attempted. Implantation of sources for a "boost" dose, either microsurgically during the initial surgical resection of the lesion before conventional teletherapy or stereotactically after conventional teletherapy, may be a valuable adjunct to external irradiation for the control of potentially devastating tumors (such as chordomas and malignant meningiomas) before they recur with the severe consequences seen in the patients reported here.
13例复发性颅底或脊柱肿瘤患者，之前已接受过放疗，此次采用显微外科或立体定向技术，通过间质植入125I源进行再次放疗。患者患有难以治疗的晚期脊索瘤、脑膜瘤、恶性脑膜瘤、纤维肉瘤、侵袭性垂体腺瘤和恶性神经鞘瘤。另外2例恶性脑膜瘤患者，在初次手术切除病变时或在常规远距离放疗后的单独手术过程中植入125I源，增加外照射剂量。将125I源显微外科植入基底肿瘤受到该区域手术固有困难的限制；无法可视化需要植入的整个肿瘤。5例脊索瘤中有3例病情稳定或好转；这些患者可能从该手术中获益。2例复发性恶性脑膜瘤患者在间质近距离放疗后长期缓解。只有尝试对这些区域进行更积极的手术暴露，间质125I近距离放疗用于颅底或脊柱旁复发性肿瘤才可能更成功。在常规远距离放疗前对病变进行初次手术切除时显微外科植入源，或在常规远距离放疗后立体定向植入源以给予“增强”剂量，对于在出现本文报道患者中所见的严重后果之前控制潜在破坏性肿瘤（如脊索瘤和恶性脑膜瘤），可能是外照射的一种有价值的辅助手段。
