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JOURNAL OF NEUROSURGICAL SCIENCES

Rivista di Neurochirurgia


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Journal of Neurosurgical Sciences 2018 April;62(2):214-20

DOI: 10.23736/S0390-5616.16.03547-X

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

Stefanie BREHMER 1, Christian V. GUTHIER 2, Sven CLAUSEN 3, Frank SCHNEIDER 3, Dirk-Michael SCHULTE 1, Matthias BENKER 4, Frederic BLUDAU 5, Gerhard GLATTING 6, Alexander MARX 7, Peter SCHMIEDEK 1, Jürgen HESSER 2, Frederik WENZ 3, Frank A. GIORDANO 3

1 Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2 Experimental Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 3 Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 4 Carl Zeiss Meditec AG, Oberkochen, Germany; 5 Department of Orthopedic and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 6 Medical Radiation Physics/Radiation Protection, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 7 Department of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany


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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.


KEY WORDS: Glioblastoma - Biopsy - Radiotherapy

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Publication History

Issue published online: March 14, 2018
Article first published online: January 15, 2016
Manuscript accepted: January 13, 2016
Manuscript received: November 16, 2015

Per citare questo articolo

Brehmer S, Guthier CV, Clausen S, Schneider F, Schulte DM, Benker M, et al. Combined stereotactic biopsy and stepping-source interstitial irradiation of glioblastoma multiforme. J Neurosurg Sci 2018;62:214-20. DOI: 10.23736/S0390-5616.16.03547-X

Corresponding author e-mail

frank.giordano@umm.de