The place of interstitial brachytherapy and radiosurgery for low-grade gliomas

  • F. W. Kreth
  • N. Thon
  • A. Siefert
  • J. C. Tonn
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 35)


Even though stereotactic brachytherapy has been used for treatment of complex located low-grade glioma for many years, its place within modern treatment concepts is still debated and only a few centers have gained experience with this complex treatment modality. The current article reviews selection criteria, treatment protocols, radiobiology, treatment effects, risk models and side effects of stereotactic brachytherapy. Potentially alternative techniques such as radiosurgery were also reviewed under consideration of radiobiological similarities and differences.


Stereotactic brachytherapy radiosurgery low-grade glioma gamma knife iodine-125 seeds 


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  1. 1.
    Aarsen FK, Paquier PF, Reddingius RE, Streng IC, Arts WF, Evera-Preesman M, Catsman-Berrevoets CE (2006) Functional outcome after low grade astrocytoma treatment in childhood. Cancer 106: 396–402PubMedGoogle Scholar
  2. 2.
    Anderson LL, Kuan HM, Ding IY (1981) Clinical dosimetry with 125I. In: Georg FW III (ed) Modem Interstitial and Intracavitary Radiation Management, pp 9–15Google Scholar
  3. 3.
    Barendsen GW (1982) Dose fractionation, dose rate and iso-effect relationship for normal tissue responses. Int J Radia Oncol Biol Phys 8: 1981–97Google Scholar
  4. 4.
    Barker FG, Chang SM, Huhn SL, Davis RL, Gutin PH, McDernott MW, Wilson CB, Prados MD (1997) Age and the risk of anaplasia in magnetic resonance-nonenhancing supratentorial cerebral tumors. Cancer 80(5): 936–41PubMedGoogle Scholar
  5. 5.
    Bauman G, Lote K, Larson D, Stalpers L, Leighton C, Fisher B, Wara W, MacDonald D, Stitt L, Cairncross JG (1999) Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis. Int J Radiat Oncol Biol Phys 45: 923–9PubMedGoogle Scholar
  6. 6.
    Beach L, Young AB, Patchell RA (1993) A template for rigid stereotaxic afterloading brachytherapy of the brain. Int J Radiat Oncol Biol Phys 26: 347–51PubMedGoogle Scholar
  7. 7.
    Bernstein M, Gutin PH (1981) Interstitial irradiation of brain tumours: a review. Neurosurgery 6: 741–50Google Scholar
  8. 8.
    Bernstein M, Lumley M, Davidson G, Laperriere N, Leung P (1993) Intracranial arterial occlusion associated with high-activity iodine-125 brachytherapy for glioblastoma. J Neurooncol 17: 253–60PubMedGoogle Scholar
  9. 9.
    Betti OO, Derechinsky VE (1984) Hyperselective encephalic irradiation with a linear accelerator. Acta Neurochir Suppl 33: 385–90Google Scholar
  10. 10.
    Boethius J, Ulfarsson E, Rähn T, Lippittz B (2002) Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg 97: 677–80PubMedGoogle Scholar
  11. 11.
    Brenner DJ, Martel MK, Hall EJ (1991) Fractionated regimes for stereotactic radiotherapy of recurrent tumours in the brain. Int J Radiat Oncol Biol Phys 21: 819–24PubMedGoogle Scholar
  12. 12.
    Dale RG (1985) The application of the linear-quadratic dose-effect equation to fractionated and protracted radiotherapy. Br J Radiol 58: 515–28PubMedGoogle Scholar
  13. 13.
    Dale RG (1989) Radiobiological assessment of permanent implants using tumour repopulation factors in the linear quadratic model. Br J Radiol 62: 241–44PubMedGoogle Scholar
  14. 14.
    Dale RG, Jones B, Coles IP (1994) Effect of tumour shrinkage on the biological effectiveness of permanent brachytherapy implants. Br J Radiol 67: 639–45PubMedGoogle Scholar
  15. 15.
    Deinsberger R, Tidstrand J (2005) Linac radiosurgery as a tool in neurosurgery. Neurosurg Rev 28: 79–88PubMedGoogle Scholar
  16. 16.
    Duffau H, Capelle L, Lopes M, Faillot T, Sichez JP, Fohanno D (2000) The insular lobe: physiopathological and surgical considerations. Neurosurgery 47: 801–10PubMedGoogle Scholar
  17. 17.
    Duffau H, Capelle L, Sichez N, Denvil D, Lopes M, Sichez JP, Bitar A, Fohanno D (2002) Intraoperative mapping of the subcortical language pathways using direct stimulations. An anatomo-functional study. Brain 125: 199–214PubMedGoogle Scholar
  18. 18.
    Duffau H, Capelle L, Lopes M, Bitar A, Sichez JP, Van Effenterre R (2002) Medically intractable epilepsy from insular low-grade glioma: improvement after an extended lesionectomy. Acta Neurochir 144: 563–72Google Scholar
  19. 19.
    Fike JR, Cann CE, Philips TL, Bernstein M, Gutin PH, Turowski K, Weaver KA, Davis RL, Higgins RJ, DaSilva V (1985) Radiation brain damage induced by interstitial 125-I sources: a canine model evaluated by quantitative computed tomography. Neurosurgery 16: 530–7PubMedGoogle Scholar
  20. 20.
    Flickinger JC, Schell MC, Larson DA (1990) Estimation of complications for linear accelerator radiosurgery with the integrated logistic formula. Int J Radiat Oncol Biol Phys 19: 143–8PubMedGoogle Scholar
  21. 21.
    Flickinger JC, Lunsford LD, Kondziolka D (1992) Dose prescription and dose-volume effects in radiosurgery. Neurosurg Clin N Am 3(1): 51–9PubMedGoogle Scholar
  22. 22.
    Fowler JF (1989) The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62: 679–94PubMedGoogle Scholar
  23. 23.
    Fowler JF (1990) Radiobiological aspects of low dose rates in radioimmunotherapy. Int J Radiat Oncol Biol Phys 18: 1261–9PubMedGoogle Scholar
  24. 24.
    Frappaz D, Chinot O, Bataillard A, Ben Hassel M, Capelle L, Chanalet S, Chatel M, Figarella-Branger D, Guegan Y, Guyotat J, Hoang-Xuan K, Jouanneau E, Keime-Guibert F, Laforet C, Linassier C, Loiseau H, Maire JP, Menei P, Rousmans S, Sanson M, Sunyach MP (2003) Summary version of the standards, options and recommendations for the management of adult patients with intracranial glioma. Br J Cancer 89(1): 73–83Google Scholar
  25. 25.
    Grasbon-Frodl EM, Kreth FW, Ruiter M, Schnell O, Bise K, Felsberg J, Reifenberger G, Tonn JC, Kretzschmar HA (2007) Intratumoural homogeneity of MGMT promotor hypermethylation as demonstrated in serial stereotactic specimens from anaplastic astrocytomas and glioblastomas. Int J Cancer 121(11): 2458–64PubMedGoogle Scholar
  26. 26.
    Gregg EC, Yau TM, Kim SC (1979) Effect of low dose rate irradiation on cell kinetics. Biophys J 28: 81–92PubMedGoogle Scholar
  27. 27.
    Groothuis DR, Wright DC, Ostertag CB (1987) The effect of 125-I interstitial radiotherapy on blood-brain barrier function in normal canine brain. J Neurosurg 67: 895–902PubMedGoogle Scholar
  28. 28.
    Gutin PH, Dormandy RH (1982) A coaxial catheter system for afterloading radioactive sources for the interstitial irradiation of brain tumours. Technical note. J Neurosurg 56: 734–5PubMedGoogle Scholar
  29. 29.
    Gutin PH, Prados MD, Phillips TL, Wara WM, Larson DA, Leibel SA, Sneed PK, Levin VA, Weaver KA, Silver P (1991) External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82-2. Int J Radiat Oncol Biol Phys 21: 601–6PubMedGoogle Scholar
  30. 30.
    Hadjipanayis CG, Kondziolka D, Gardner P, Niranjan A, Dagam S, Flickinger JC (2002) Stereotactic radiosurgery for pilocytic astrocytomas when mulimodal therapy is necessary. J Neurosurg 97: 56–64PubMedGoogle Scholar
  31. 31.
    Hadjipanayis CG, Niranjan A, Tyler-Kabara E, Kondziolka D, Flickinger JC, Lunsford LD (2002) Stereotactic radiosurgery for well-circumscribed fibrillary grade II astrocytomas: an initial experience. Stereotact Funct Neurosurg 79: 13–24PubMedGoogle Scholar
  32. 32.
    Hadjipanayis CG, Kondziolka D, Flickinger JC, Lunsford LD (2003) The role of stereotactic radiosurgery for low grade astrocytomas. Neurosurg Focus 14: e15PubMedGoogle Scholar
  33. 33.
    Haglund MM, Berger MS, Shamseldin M, Lettich E, Ojemann GA (1994) Cortical localization of temporal lobe language sites in patients with glioma. Neurosurgery 34: 567–76PubMedGoogle Scholar
  34. 34.
    Hall EJ (1988) Repair of radiation damage and the dose-rate effect. In: Hall EJ (ed) Radiobiology for the Radiologist. JB Lipincott, Philadelphia, pp 107–31Google Scholar
  35. 35.
    Hegedus B, Zach J, Czirok A, Lövey J, Vicsek T (2004) Irradiation and taxol treatment result in non-monotonous, dose-dependent changes in the motility of glioblastoma cells. J Neurooncol 67: 147–57PubMedGoogle Scholar
  36. 36.
    Herrera EJ, Viano JC, Gómez JM, Surur A, Suárez JC (2007) Interstitial stereotactic radiosurgery of pilocytic astrocytomas in paediatric patients. Acta Neurochir 149: 887–96Google Scholar
  37. 37.
    Heppner PA, Sheehan JP, Steiner LE (2005) Gamma knife surgery for low-grade gliomas. Neurosurgery 57: 1132–38PubMedGoogle Scholar
  38. 38.
    Jackson RJ, Fuller GN, Abi-Said D, Lang FF, Gokaslan ZL, Shi WM, Wildrick DM, Sawaya R (2001) Limitations of stereotactic biopsy in the initial management of gliomas. Neuro Oncol 3: 193–200PubMedGoogle Scholar
  39. 39.
    Janzer RC, Kleihues P, Ostertag CB (1986) Early and late effects on the normal dog brain of permanent interstitial iridium-192 irradiation. Acta Neuropathol 70: 91–102PubMedGoogle Scholar
  40. 40.
    Julow J, Szeifert GT, Bálint K, Nyáry I, Nemes Z (2007) The role of microglia/macrophage system in the tissue response to I-125 interstitial brachytherapy of cerebral gliomas. Neurol Res 2: 233–38Google Scholar
  41. 41.
    Karim ABMF, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O, Darcel F, Stenning S, Pierart M, Van Glabbeke M (2002) Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer (EORTC) study BR04: an interim analysis. Int J Radiation Oncology Biol Phys 52: 316–24Google Scholar
  42. 42.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod M (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 1991–2005Google Scholar
  43. 43.
    Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS (2004) Intraoperative subcortical stimulation mapping for hemispherical perirolandic glioma located within or adjacent to the descending motor pathways: pevaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg 100: 369–75PubMedGoogle Scholar
  44. 44.
    Kida Y, Kobayashi T, Mori Y (2000) Gamma knife radiosurgery for low grade astrocytomas: results of long-term follow up. J Neurosurg 93: 42–46PubMedGoogle Scholar
  45. 45.
    Kiessling M, Kleihues P, Gassega E, Mundinger F, Ostertag CB, Weigel K (1984) Morphology of intracranial tumours and adjacent brain structures following interstitial iodine-125 radiotherapy. Acta Neurochir 33: 281–89Google Scholar
  46. 46.
    Kjellberg RN, Hanamura T, Davis KR, Lyons SL, Adams RD (1983) Bragg-peak protonbeam therapy for arteriovenous malformations of the brain. N Engl J Med 309(5): 269–74PubMedGoogle Scholar
  47. 47.
    Klein M, Heimans JJ, Aaronson NK, van der Ploeg HM, Grit J, Muller M, Pstma TJ, Mooij JJ, Boerman RH, Beute GN, Ossenkoppele GJ, van Imhoff GW, Dekker AW, Jolles J, Slotman BJ, Struikmans H, Taphoorn MJ (2002) Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet 360: 1361–68PubMedGoogle Scholar
  48. 48.
    Kondziolka D, Lunsford LD, Claassen D, Pandalai S, Maitz AH, Flickinger JC (1992) Radiobiology of radiosurgery: Part II. The rat C6 glioma model. Neurosurgery 31: 280–7PubMedGoogle Scholar
  49. 49.
    Kondziolka, D, Lunsford LD, Martinez AJ (1993) Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low grade) astrocytoma. J Neurosurg 79: 533–36PubMedGoogle Scholar
  50. 50.
    Kondziolka D, Lunsford LD, Flickinger JC (1999) The radiobiology of radiosurgery. Neurosurg Clin N Amer 10(2): 157–66Google Scholar
  51. 51.
    Kondziolka D, Lunsford LD, Witt TC, Flickinger JC (2000) The future of radiosurgery: radiobiology, technology, and applications. Radiosurgery, 54: 406–14Google Scholar
  52. 52.
    Kreth FW, Faist M, Warnke PC, Rossner R, Volk B, Ostertag CB (1995) Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82: 418–29PubMedGoogle Scholar
  53. 53.
    Kreth FW, Faist M, Rossner R, Birg W, Volk B, Ostertag CB (1997) The risk of interstitial radiotherapy of low-grade gliomas. Radiother Oncol 43: 253–60PubMedGoogle Scholar
  54. 54.
    Kreth FW, Faist M, Rossner R, Volk B, Ostertag CB (1997) Supratentorial World Health Organization Grade 2 Astrocytomas and Oligoastrocytomas: a new pattern of prognostic factors. Cancer 79: 370–79PubMedGoogle Scholar
  55. 55.
    Kreth FW, Muacevic A, Medele R, Bise K, Meyer T, Reulen HJ (2001) The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours — a prospective study. Acta Neurochir 143: 539–45Google Scholar
  56. 56.
    Kreth FW, Faist M, Grau S, Ostertag CB (2006) Interstitial 125I radiosurgery of supratentorial de novo WHO grade II astrocytoma and oligoastrocytoma in adults: long-term results and prognostic factors. Cancer 106: 1372–81PubMedGoogle Scholar
  57. 57.
    Krishnaswamy V (1978) Dose distribution around an 125-I seed source in tissue. Radiology 126: 489–91PubMedGoogle Scholar
  58. 58.
    Krishnaswamy V (1979) Dose Tables for 125-I seed implants. Radiology 132: 727–30PubMedGoogle Scholar
  59. 59.
    Laperriere N, Leung P, McKenzie S, Milosevic M, Wong S, Glen J (1998) Randomized Study of Brachytherapy in the initial management of Patients with Malignant astrocytoma. Int J Radiat Oncol Biol Phys 41: 1005–11PubMedGoogle Scholar
  60. 60.
    Lapierre NJ (2000) Brachytherapy. In: Bernstein M, Berger MS (eds) Neuro-Oncology: The Essentials. Thieme Medical Publishers, Inc., New York, pp 200–13Google Scholar
  61. 61.
    Lang FF, Olansen NE, DeMonte F, Gokaslan ZL, Holland EC, Kalhorn C, Sawaya R (2001) Surgical resection of intrinsic insular tumours: complication avoidance. J Neurosurg 95: 638–50PubMedGoogle Scholar
  62. 62.
    Larson DA, Flickinger JC, Loeffler JS (1993) The radiobiology of radiosurgery. Int J Radiat Oncol Biol Phys 25: 557–61PubMedGoogle Scholar
  63. 63.
    Larson DA, Gutin PH, McDermott M, Lamborn KR, Sneed P, Wara WM (1995) Gamma knife for glioma: selection factors and survival. Int J Radiat Oncol Biol Phys 36(5): 1045–53Google Scholar
  64. 64.
    Larsson B (1992) Radiobiological fundamentals in radiosurgery. In: Steiner L (ed) Radiosurgery: Baseline and Trends. Raven Press, New York, pp 3–14Google Scholar
  65. 65.
    Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102: 316PubMedGoogle Scholar
  66. 66.
    Leksell L (1968) Cerebral radiosurgery I. Gammathalamotomy in two cases of intractable pain. Acta Chir Scand 134: 585–95PubMedGoogle Scholar
  67. 67.
    Ling CC (1992) Permanent implants using Au-198, Pd-103 and I-125: radiobiological considerations based on the linear quadratic model. Int J Radiation Oncology Biol Phys 23: 81–87Google Scholar
  68. 68.
    Ling CC and Chui CS (1993) Stereotactic treatment of brain tumours with radioactive implants or external beams: radiophysical aspects. Radiother Oncol 26: 11–18PubMedGoogle Scholar
  69. 69.
    Luxton G, Petrovich Z, Jozsef G (1993) Stereotactic radiosurgery: principles and comparison of treatment methods. Neurosurgery 32: 241–59PubMedGoogle Scholar
  70. 70.
    Marks JE, Baglan RJ, Prassad SC, Blank WF (1981) Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 7: 243–52PubMedGoogle Scholar
  71. 71.
    Mehrkens JH, Kreth FW, Muacevic A, Ostertag CB (2004) Long term course of WHO grade II astrocytomas of the Insula of Reil after I-125 interstitial irradiation. J Neurol 251(12): 1455–64PubMedGoogle Scholar
  72. 72.
    Muacevic A, Kreth FW (2003) Significance of stereotactic biopsy for the management of WHO grade II supratentorial glioma. Nervenarzt 74: 350–54PubMedGoogle Scholar
  73. 73.
    Mundinger F, Birg W, Klar M (1978) Computer-assisted stereotactic brain operations by means including computerized axial tomography. Appl Neurophysiol 41(1–4): 169–82PubMedGoogle Scholar
  74. 74.
    Mundinger F, Birg W, Ostertag CB (1978) Treatment of small cerebral gliomas with CT-aided stereotaxic Curietherapy. Neuroradiology 16: 564–67PubMedGoogle Scholar
  75. 75.
    Mundinger F, Braus DF, Krauss JK, Birg W (1991) Long-term outcome of 89 low grade brain-stem gliomas after interstitial radiation therapy. J Neurosurg 75: 740–46PubMedGoogle Scholar
  76. 76.
    Nedzi LA, Kooy H, Alexander E, Gelman RS, Loeffler JS (1991) Variables associated with the development of complications from radiosurgery of intracranial tumours. Int J Radiat Oncol Biol Phys 21: 591–99PubMedGoogle Scholar
  77. 77.
    Ojemann JG, Miller JW, Silbergeld DL (1996) Preserved function in brain invaded by tumour. Neurosurgery 39: 253–58PubMedGoogle Scholar
  78. 78.
    Ostertag CB, Groothuis D, Kleihues P (1984) Experimental data on early and late morphologic effects of permanently implanted gamma and beta sources (Iridium-192, Iodine-125 and Yttrium-90) in the brain. Acta Neurochir Suppl 33: 271–80Google Scholar
  79. 79.
    Ostertag CB (1993) Brachytherapy — Interstitial Implant Radiosurgery. Acta Neurochir 58: 79–84Google Scholar
  80. 80.
    Peraud A, Kreth FW, Wiestler OD, Kleihues P, Reulen HJ (2002) Prognostic impact of TP53 mutations and P53 protein overexpression in supratentorial WHO Grade II astrocytomas and oligoastrocytomas. Clin Cancer Res 8: 1117–24PubMedGoogle Scholar
  81. 81.
    Peraud A, Meschede M, Eisner W, Ilmberger J, Reulen HJ (2002) Surgical resection of grade II astrocytomas in the superior frontal gyrus. Neurosurgery 50: 966–75PubMedGoogle Scholar
  82. 82.
    Peraud A, Ilmberger J, Reulen HJ (2004) Surgical resection of glioma WHO grade II and III located in the opercular region. Acta Neurochir (Wien) 146: 9–17Google Scholar
  83. 83.
    Peraud A, Goetz C, Siefert A, Tonn JC, Kreth FW (2007) Interstitial iodine-125 radiosurgery alone or in combination with microsurgery for pediatric patients with eloquently located low-grade glioma: a pilot study. Childs Nerv Syst 23: 39–46PubMedGoogle Scholar
  84. 84.
    Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P, Afra D, Cornu P, Bolla M, Vecht C, Karim AB, European Oragnisation for Research and Treatment of Cancer Brain Tumor Cooperative Group, European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20(8): 2076–84PubMedGoogle Scholar
  85. 85.
    Pöpperl G, Kreth FW, Mehrkens JH, Herms J, Seelos K, Koch W, Gildehaus FJ, Kretzschmar HA, Tonn JC, Tatsch K (2007) FET PET for the evaluation of untreated gliomas: correlation of FET uptake and uptake kinetics with tumour grading. Eur J Nucl Med Mol Imaging 12: 1933–42Google Scholar
  86. 86.
    Pollack IF, Pang D, Albright AL (1994) The long-term outcome in children with late-onset aqueductal stenosis resulting from benign intrinsic tectal tumours. J Neurosurg 80: 536–47Google Scholar
  87. 87.
    Robertson PL, Muraszko KM, Brunberg JA, Axtell RA, Dauser RC, Turrisi AT (1995) Pediatric midbrain tumours: a benign subgroup of brainstem gliomas. Pediatr Neurosurg 22(2): 65–73PubMedGoogle Scholar
  88. 88.
    Schatz CR, Kreth FW, Faist M, Warnke PC, Volk B, Ostertag CB (1994) Interstitial 125-iodine radiosurgery of low-grade glioma of the insula of Reil. Acta Neurochir (Wien) 130: 80–89Google Scholar
  89. 89.
    Scharfen CO, Sneed PK, Wara WM, Larson DA, Phillips TL, Prados MD, Weaver KA, Malec M, Acord P, Lamborn KR (1992) High activity iodine-125 interstitial implant for gliomas. Int J Radiat Oncol Biol Phys 24: 583–91PubMedGoogle Scholar
  90. 90.
    Schnell O, Schöller K, Ruge M, Siefert A, Tonn JC, Kreth FW (2008) Surgical resection plus stereotactic (125)I brachytherapy in adult patients with eloquently located supratentorial WHO grade II glioma — Feasibility and outcome of a combined local treatment concept. J Neurol (Epub ahead of print)Google Scholar
  91. 91.
    Shinoda J, Yano H, Ando H, Ohe N, Sakai N, Saio M (2002) Radiological response and histological changes in malignant astrocytic tumours after stereotactic radiosurgery. Brain Tumour Pathol 19: 83–92Google Scholar
  92. 92.
    Smith V, Verhey L, Serago C (1998) Comparison of radiosurgery treatment modalities based on complication and control probabilities. Int J Radiation Oncology Biol Phys 40(2): 507–13Google Scholar
  93. 93.
    Ständer M, Peraud A, Leroch B, Kreth FW (2004) Prognostic impact of TP53 mutation status for adult patients with supratentorial World Health Organization Grade II astrocytoma or oligoastrocytoma: a long-term analysis. Cancer 101: 1028–35PubMedGoogle Scholar
  94. 94.
    Steinbok P (1994) Management and outcome of low grade astrocytomas of the midline in children. A retrospective review. Neurosurgery 35: 342–43PubMedGoogle Scholar
  95. 95.
    Sutton LN, Molloy PT, Sernyak H, Goldwein J, Phillips PF, Rorke LB, Moshang T Jr, Lange B, Packer RJ (1995) Long-term outcome of hypothalamic/chiasmatic astrocytomas in children treated with conservative surgery. J Neurosurg 83(4): 583–89PubMedGoogle Scholar
  96. 96.
    Szeifert GT, Kondziolka D, Atteberry DS, Salmon I, Rorive S, Levivier M, Lunsford LD (2007) Radiosurgical pathology of brain tumours: metastasis, schwannomas, meningiomas, astrocytomas, hemangioblastomas. Prog Neurol Surg 20: 91–105PubMedGoogle Scholar
  97. 97.
    Szeifert G, Kondziolka D, Lunsford L, Nyary I, Hanzely Z, Salmon I, Levivier M (2007) Introduction: the contribution of pathology to radiosurgery. In: Szeifert GT, Kondziolka D, Levivier M, Lunsford (eds) Radiosurgery and Pathological Fundamentals. Prog Neurol Surg 20: 1–15Google Scholar
  98. 98.
    Szeifert GT, Prasad D, Kamyrio T, Steiner M, Steiner LE (2007) The role of the Gamma Knife in the management of cerebral astrocytomas. Prog Neurol Surg 20: 150–63PubMedGoogle Scholar
  99. 99.
    Thwaites DI, Tuohy JC (2006) Back to the future: the history and development of the clinical linear accelerator. Phys Med Biol 51: 343–62Google Scholar
  100. 100.
    Treuer H, Klein D, Maarouf M, Lehrke R, Voges J, Sturm V (2005) Accuracy and conformity of stereotactically guided interstitial brain tumour therapy using I-125 seeds. Radiother Oncol 77: 202–09PubMedGoogle Scholar
  101. 101.
    Vanaclocha V, Saiz-Sapena N, Garcia-Casasola C (1997) Surgical treatment of insular glioma. Acta Neurochir (Wien) 139: 1126–34Google Scholar
  102. 102.
    Verhey LJ, Smith V, Serago CF (1998) Comparison of radiosurgery treatment modalities based on physical dose distributions. Int J Radiat Oncol Biol Phys 40(2): 497–505PubMedGoogle Scholar
  103. 103.
    Viola A, Major T, Julow J (2006) Comparison of 125I stereotactic brachytherapy and LINAC radiosurgery modalities based on physical dose distribution and radiobiological efficacy. Radiation Res 165: 695–702PubMedGoogle Scholar
  104. 104.
    Vitaz TW, Warnke PC, Tabar V, Gutin PH (2005) Brachytherapy for brain tumours. J Neuro-Oncol 73: 71–86Google Scholar
  105. 105.
    Voges J, Treuer H, Schlegel W, Pastyr O, Sturm V (1993) Interstitial irradiation of cerebral gliomas with stereotactically implanted iodine-25 seeds. Acta Neurochir Suppl 58: 108–11Google Scholar
  106. 106.
    Voges J, Treuer H, Sturm V, Büchner C, Lehrke R, Kocher M, Staar S, Kuchta J, Müller RP (1996) Risk analysis of linear accelerator radiosurgery. Int J Radiat Oncol Biol Phys 36: 1055–63PubMedGoogle Scholar
  107. 107.
    Warnke P, Berlis A, Weyerbrock A, Ostertag CB (1997) Significant reduction of seizure incidence and increase of benzodiazepine receptor density after interstitial radiosurgery in low-grade gliomas. Acta Neurochir (Wien) Suppl 68: 90–92Google Scholar
  108. 108.
    Warnke PC, Hans FJ, Ostertag CB (1993) Impact of stereotactic interstitial radiation on brain capillary physiology. Acta Neurochir (Wien) 64: 85–88Google Scholar
  109. 109.
    Weckesser M, Langen KJ, Rickert CH, Kloska S, Straeter R, Hamacher K, Kurlemann G, Wassmann H, Coenen HH, Schober O (2005) O-(2-[18F]fluorethyl)-L-tyrosine PET in the clinical evaluation of primary brain tumours. Eur J Nucl Med Mol Imaging 32: 422–29PubMedGoogle Scholar
  110. 110.
    Weller M, Berger H, Hartmann C, Schramm J, Westphal M, Simon M, Goldbrunner R, Krex D, Steinbach JP, Ostertag CB, Loeffler M, Pietsch T, von Deimling A, German Glioma Network (2007) Combined 1p/19q loss in oligodendroglial tumours: predictive or prognostic biomarker? Clin Cancer Res 13: 6933–37PubMedGoogle Scholar
  111. 111.
    Wowra B, Schmitt HP, Sturm V (1989) Incidence of late radiationnecrosis with transient mass effect after interstitial low dose rateradiotherapy for cerebral gliomas. Acta Neurochir (Wien) 99: 104–08Google Scholar
  112. 112.
    Yen CP, Sheehan J, Steiner M, Patterson G, Steiner L (2007) Gamma knife surgery for focal brainstem gliomas. J Neurosurg 106: 8–17PubMedGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2010

Authors and Affiliations

  • F. W. Kreth
    • 1
  • N. Thon
    • 1
  • A. Siefert
    • 2
  • J. C. Tonn
    • 1
  1. 1.Department of Neurosurgery, University Hospital GrosshadernUniversity of MunichMunichGermany
  2. 2.Department of Radiotherapy and Radiooncology, University Hospital GrosshadernUniversity of MunichMunichGermany

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