KMID : 1001920130540030175
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Journal of Korean Neurosurgical Society 2013 Volume.54 No. 3 p.175 ~ p.182
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Intracavitary Radiation Therapy for Recurrent Cystic Brain Tumors with Holmium-166-Chico : A Pilot Study
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Ha Eun-Jin
Gwak Ho-Shin Rhee Chang-Hun Youn Sang-Min Choi Chang-Woon Cheon Gi-Jeong
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Abstract
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Objective: Intracavitary injection of beta-emitting radiation source for control of cystic tumors has been tried with a benefit of localized internal radiation. The authors treated cystic brain tumor patients with Holmium-166-chitosan complex (Ho-166-chico), composed of a beta-emitting radionuclide Holmium-166 and biodegradable chit polymer, and evaluated the safety and effective measurement for response.
Methods: Twenty-two patients with recurrent cystic brain tumor and/or located in a deep or eloquent area were enrolled in this pilot study. The cyst volume and wall thickness were determined on CT or MRI to assess radiological response. The activity of Ho-166-chico injected via Ommaya reservoir was prescribed to be 10-25 Gy to the cyst wall in a depth of 4 mm.
Results: There was neither complications related to systemic absorption nor leakage of Ho-166-chico in all 22 patients. But, two cases of oculomotor paresis were observed in patients with recurrent craniopharyngioma. Radiological response was seen in 14 of 20 available follow-up images (70%). Seven patients of ¡¯evident¡¯ radiological response experienced more than 25% decrease of both cyst volume and wall thickness. Another 7 patients with ¡¯suggestive¡¯ response showed decrease of cyst volume without definitive change of the wall thickness or vice versa. All patients with benign tumors or low grade gliomas experienced symptomatic improvement.
Conclusion: Ho-166-chico intracavitary radiation therapy for cystic tumor is a safe method of palliation without serious complications. The determination of both minimal effective dosage and time interval of repeated injection through phase 1 trial could improve the results in the future.
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KEYWORD
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Holmium, Chitosan, Intracavitary radiation, Intracranial cyst
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