Continuous low dose rate brachytherapy with high activity iodine-125 seeds in the management of meningiomas

The purpose of this study was to evaluate if meningiomas can be effectively treated with brachytherapy using permanent implantation of high activity 1-125 seeds. Thirteen patients with intracranial meningiomas were treated by means of permanent stereotactic implantation of one or more high-activity 1-125 seeds. The physical characteristics of I-25 enabled us to deliver a minimum tumor dose ranging from 100 Gy to 500 Gy at a low dose rate of 5 cGy to 25 cGy per hr. Indications for this procedure included recurrence after initial surgery or as primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 25 months. Nine of 13 patients achieved complete resolution of the tumor and in the remaining four, more than 50 reduction in tumor volume was noted at the last follow-up. No late complications were observed. We conclude from this initial data that localized high dose irradiation delivered at a low dose rate using 1-125 permanent implantation is an effective, safe, and simple method in the treatment of both recurrent and primary intracranial meningiomas.