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

• Verfasst von: Brehmer, Stefanie [VerfasserIn]
• Verfasst von: Clausen, Sven [VerfasserIn]
• Verfasst von: Schneider, Frank [VerfasserIn]
• Verfasst von: Schulte, Dirk Michael [VerfasserIn]
• Verfasst von: Bludau, Frederic [VerfasserIn]
• Verfasst von: Glatting, Gerhard [VerfasserIn]
• Verfasst von: Marx, Alexander [VerfasserIn]
• Verfasst von: Schmiedek, Peter [VerfasserIn]
• Verfasst von: Hesser, Jürgen [VerfasserIn]
• Verfasst von: Wenz, Frederik [VerfasserIn]
• Verfasst von: Giordano, Frank Anton [VerfasserIn]
• Titel: Combined stereotactic biopsy and stepping-source interstitial irradiation of glioblastoma multiforme
• Verf.angabe: Stefanie Brehmer, Christian V. Guthier, Sven Clausen, Frank Schneider, Dirk-Michael Schulte, Matthias Benker, Frederic Bludau, Gerhard Glatting, Alexander Marx, Peter Schmiedek, Jürgen Hesser, Frederik Wenz, Frank A. Giordano
• Jahr: 2018
• Umfang: 7 S.
• Fussnoten: Article first published online: January 15, 2016 ; Gesehen am 06.08.2019
• Titel Quelle: Enthalten in: The journal of neurosurgical sciences
• Ort Quelle: Torino : Ed. Minerva Medica, 1998
• Jahr Quelle: 2018
• Band/Heft Quelle: 62(2018), 2, Seite 214-220
• ISSN Quelle: 1827-1855
• DOI: doi:10.23736/S0390-5616.16.03547-X
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1670665690

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.