ArticleCureus2021
GammaTile Brachytherapy Combined With External Beam Radiation Therapy for the Treatment of a Partially Resected Secondary Glioblastoma (WHO Grade 4 IDH-Mutant Astrocytoma): Matching External Beam Dose Gradient to Brachytherapy Dose Fall-Off.
Article in Cureus, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed, 6 citations in OpenAlex.
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Reirradiation of recurrent glioblastomas is most commonly managed with hypofractionated external beam radiation with a modest overall effect. GammaTile, which is a Cesium-131 source embedded in collagen mesh, is an approach that allows the surgical bed of resectable intracranial tumors to receive a greater biological dose than is possible with any form of external beam radiation therapy (EBRT). In this case report, a 28-year-old male presents with a WHO grade 4 isocitrate dehydrogenase (IDH)-mutant astrocytoma (formerly secondary glioblastoma) of the left occipital/parietal lobe after receiving 45 Gy and two cycles of adjuvant temozolomide four years prior for a grade 3 IDH-mutant astrocytoma. The patient proceeded to undergo craniotomy with maximal safe resection and application of GammaTile to a dose of 60 Gy at 5mm depth. Shortly afterward, he developed symptomatic progression of disease in the bilateral splenium and left thalamus/basal ganglia. We irradiated the undertreated residual disease with EBRT to a dose of 35 Gy in 10 fractions without introducing excessive dose to the GammaTile irradiated volume. This was achieved by creating one portion of the planning target volume with a homogeneous dose and another part where the delivered dose decreased with the GammaTile dose buildup. Treatment planning utilized the Gradient Optimization feathering technique with non-coplanar volumetric modulated arc therapy. The resulting composite between the hypofractionated EBRT and GammaTile dose distribution created an approximate dose equivalent of 50 Gy in 2 Gy fractions to the residual disease with no hot spots or areas of under coverage. This is the first report showing the feasibility of combining GammaTile with dose-matched EBRT volumes in a reproducible manner to sub-totally resected, recurrent intracranial neoplasms.
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