Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic iodine-125 brachytherapy for treatment of inoperable focal brainstem gliomas of WHO grades I and II: feasibility and long-term outcome

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Microsurgical resection is the most frequently suggested treatment option for accessible focal brainstem gliomas (F-BSG) of World Health Organization (WHO) grades I and II. Because of their location in the highly eloquent brain, however, resection is associated with permanent postoperative morbidity, ranging from 12 to 33 %. Only a few reports have suggested stereotactic brachytherapy (SBT) with implantation of iodine-125 seeds as a local treatment alternative. Between 1993 and 2010, 47 patients were treated with SBT (iodine-125 seeds; cumulative surface dose 50–65 Gy) for inoperable F-BSG, WHO grades I and II, in one of the largest reported patient series. We evaluated procedure-related complications, clinical outcome, and progression-free and overall survival (PFS, OS). Median follow-up was 81.6 months. Procedure-related mortality was zero. Within 30 days of seed implantation six patients (12.8 %) had transient neurological deficits. Two patients (4.3 %) deteriorated permanently. Space-occupying cysts occurred in six patients (12.8 %) after a median of 28.5 months, and required surgical intervention. Nine patients (19.1 %) presented with tumor relapse after a median of 56.6 months (range 7.9–118.0 months). For the remaining 38 patients complete response was observed for 23.4 %, partial response for 29.8 %, and stable disease for 27.7 %. Actuarial PFS was 97.7 ± 2.2, 92.8 ± 4.0, 81.2 ± 6.5, and 62.0 ± 10.4 % after 1, 2, 5, and 10 years, respectively. Corresponding OS was 100 ± 0.0 % (1 and 2 years), 97.4 ± 2.6 % (5 years), and 87.6 ± 7.0 % (10 years). SBT is a comparatively safe, minimally invasive, and highly effective local treatment option for patients with inoperable F-BSG WHO grades I and II; it merits further evaluation in prospective randomized trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fisher PG, Carson BS (1996) Management of brainstem gliomas in children. Contemp Neurosurg 18(24):1–6

    Google Scholar 

  2. White HH (1963) Brain stem tumors occurring in adults. Neurology 13:292–300

    Article  PubMed  CAS  Google Scholar 

  3. Jallo GI, Biser-Rohrbaugh A, Freed D (2004) Brainstem gliomas. Childs Nerv Syst 20(3):143–153

    Article  PubMed  Google Scholar 

  4. Freeman CR, Farmer JP (1998) Pediatric brain stem gliomas: a review. Int J Radiat Oncol Biol Phys 40(2):265–271

    Article  PubMed  CAS  Google Scholar 

  5. Hong S, Kim IH, Wang KC (2005) Outcome and prognostic factors of childhood diffuse brainstem glioma. Cancer Res Treat 37(2):109–113

    Article  PubMed  Google Scholar 

  6. Sandri A, Sardi N, Genitori L, Giordano F, Peretta P, Basso ME, Bertin D, Mastrodicasa L, Todisco L, Mussa F, Forni M, Ricardi U, Cordero di Montezemolo L, Madon E (2006) Diffuse and focal brain stem tumors in childhood: prognostic factors and surgical outcome. Experience in a single institution. Childs Nerv Syst 22(9):1127–1135

    Google Scholar 

  7. Teo C, Siu TL (2008) Radical resection of focal brainstem gliomas: Is it worth doing? Childs Nerv Syst 24(11):1307–1314

    Article  PubMed  Google Scholar 

  8. Recinos PF, Sciubba DM, Jallo GI (2007) Brainstem tumors: Where are we today? Pediatr Neurosurg 43(3):192–201

    Article  PubMed  Google Scholar 

  9. Farmer JP, Montes JL, Freeman CR, Meagher-Villemure K, Bond MC, O’Gorman AM (2001) Brainstem gliomas. A 10-year institutional review. Pediatr Neurosurg 34(4):206–214

    Article  PubMed  CAS  Google Scholar 

  10. Lesniak MS, Klem JM, Weingart J, Carson BS Sr (2003) Surgical outcome following resection of contrast-enhanced pediatric brainstem gliomas. Pediatr Neurosurg 39(6):314–322

    Article  PubMed  Google Scholar 

  11. Kestle J, Townsend JJ, Brockmeyer DL, Walker ML (2004) Juvenile pilocytic astrocytoma of the brainstem in children. J Neurosurg 101(1 Suppl):1–6

    PubMed  Google Scholar 

  12. Pierre-Kahn A, Hirsch JF, Vinchon M, Payan C, Sainte-Rose C, Renier D, Lelouch-Tubiana A, Fermanian J (1993) Surgical management of brain-stem tumors in children: results and statistical analysis of 75 cases. J Neurosurg 79(6):845–852

    Article  PubMed  CAS  Google Scholar 

  13. Pollack IF, Hoffman HJ, Humphreys RP, Becker L (1993) The long-term outcome after surgical treatment of dorsally exophytic brain-stem gliomas. J Neurosurg 78(6):859–863

    Article  PubMed  CAS  Google Scholar 

  14. Bowers DC, Liu Y, Leisenring W, McNeil E, Stovall M, Gurney JG, Robison LL, Packer RJ, Oeffinger KC (2006) Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study. J Clin Oncol 24(33):5277–5282

    Article  PubMed  Google Scholar 

  15. Neglia JP, Robison LL, Stovall M, Liu Y, Packer RJ, Hammond S, Yasui Y, Kasper CE, Mertens AC, Donaldson SS, Meadows AT, Inskip PD (2006) New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 98(21):1528–1537

    Article  PubMed  Google Scholar 

  16. Dirks PB, Jay V, Becker LE, Drake JM, Humphreys RP, Hoffman HJ, Rutka JT (1994) Development of anaplastic changes in low-grade astrocytomas of childhood. Neurosurgery 34(1):68–78

    Article  PubMed  CAS  Google Scholar 

  17. Duffner PK, Cohen ME, Thomas PR, Lansky SB (1985) The long-term effects of cranial irradiation on the central nervous system. Cancer 56(7 Suppl):1841–1846

    Article  PubMed  CAS  Google Scholar 

  18. Merchant TE, Conklin HM, Wu S, Lustig RH, Xiong X (2009) Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: prospective evaluation of cognitive, endocrine, and hearing deficits. J Clin Oncol 27(22):3691–3697

    Article  PubMed  Google Scholar 

  19. Ruge MI, Simon T, Suchorska B, Lehrke R, Hamisch C, Koerber F, Maarouf M, Treuer H, Berthold F, Sturm V, Voges J (2011) Stereotactic brachytherapy with iodine-125 seeds for the treatment of inoperable low-grade gliomas in children: long-term outcome. J Clin Oncol 29(31):4151–4159

    Google Scholar 

  20. Suchorska B, Ruge M, Treuer H, Sturm V, Voges J (2011) Stereotactic brachytherapy of low-grade cerebral glioma after tumor resection. Neuro Oncol 13(10):1133–1142

    Article  PubMed  Google Scholar 

  21. Kreth F, Faist M, Grau S, Ostertag C (2006) Interstitial 125I radiosurgery of supratentorial de novo WHO Grade 2 astrocytoma and oligoastrocytoma in adults: long-term results and prognostic factors. Cancer 106(6):1372–1381

    Article  PubMed  Google Scholar 

  22. Kreth FW, Thon N, Siefert A, Tonn JC (2010) The place of interstitial brachytherapy and radiosurgery for low-grade gliomas. Adv Tech Stand Neurosurg 35:183–212

    Article  PubMed  CAS  Google Scholar 

  23. 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(5):740–746

    Article  PubMed  CAS  Google Scholar 

  24. Julow J, Viola A, Major T, Valalik I, Sagi S, Mangel L, Kovacs BR, Repa I, Bajzik G, Zoltan TN, Nemeth G (2004) Iodine-125 brachytherapy of brain stem tumors. Strahlenther Onkol 180(7):449–454

    Article  PubMed  Google Scholar 

  25. Chuba PJ, Zamarano L, Hamre M, Bhambhani K, Canady A, Guys MB, Matter A, Portillo G, Chung-bin S, Fontanesi J (1998) Permanent I-125 brain stem implants in children. Childs Nerv Syst 14(10):570–577

    Article  PubMed  CAS  Google Scholar 

  26. Voges J, Treuer H, Schlegel W, Pastyr O, Sturm V (1993) Interstitial irradiation of cerebral gliomas with stereotactically implanted iodine-125 seeds. Acta Neurochir Suppl (Wien) 58:108–111

    CAS  Google Scholar 

  27. Voges J, Sturm VV (1999) Interstitial irradiation with stereotactically implanted I-125 seeds for the treatment of cerebral glioma. Crit Rev Neurosurg 9(4):223–233

    Article  PubMed  Google Scholar 

  28. Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. Columbia University Press, New York

    Google Scholar 

  29. Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2(5):200–215

    PubMed  CAS  Google Scholar 

  30. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607

    Article  PubMed  Google Scholar 

  31. Ruge MI, Ilmberger J, Tonn JC, Kreth FW (2011) Health-related quality of life and cognitive functioning in adult patients with supratentorial WHO grade II glioma: status prior to therapy. J Neurooncol 103(1):129–136

    Article  PubMed  Google Scholar 

  32. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8(7):1277–1280

    PubMed  CAS  Google Scholar 

  33. Ruge MI, Suchorska B, Maarouf M, Runge M, Treuer H, Voges J, Sturm V (2011) Stereotactic 125 iodine brachytherapy for the treatment of singular brain metastases: Closing a gap? Neurosurgery 68(5):1209–1219

    PubMed  Google Scholar 

  34. Ruge MI, Kickingereder P, Grau S, Hoevels M, Treuer H, Sturm V (2011) Stereotactic biopsy combined with stereotactic (125) iodine brachytherapy for diagnosis and treatment of locally recurrent single brain metastases. J Neurooncol 105(1):109–118

    Article  PubMed  Google Scholar 

  35. Sturm V, Pastyr O, Schlegel W, Scharfenberg H, Zabel HJ, Netzeband G, Schabbert S, Berberich W (1983) Stereotactic computer tomography with a modified Riechert–Mundinger device as the basis for integrated stereotactic neuroradiological investigations. Acta Neurochir (Wien) 68(1–2):11–17

    Article  CAS  Google Scholar 

  36. Selker RG, Shapiro WR, Burger P, Blackwood MS, Arena VC, Gilder JC, Malkin MG, Mealey JJ, Jr. Neal JH, Olson J, Robertson JT, Barnett GH, Bloomfield S, Albright R, Hochberg FH, Hiesiger E, Green S (2002) The brain tumor cooperative group NIH trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine. Neurosurgery 51(2):343–355 (discussion 355–347)

    Google Scholar 

  37. Laperriere NJ, Leung PM, McKenzie S, Milosevic M, Wong S, Glen J, Pintilie M, Bernstein M (1998) Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys 41(5):1005–1011

    Article  PubMed  CAS  Google Scholar 

  38. Chamberlain MC, Barba D, Kormanik P, Berson AM, Saunders WM, Shea MC (1995) Concurrent cisplatin therapy and iodine 125 brachytherapy for recurrent malignant brain tumors. Arch Neurol 52(2):162–167

    Article  PubMed  CAS  Google Scholar 

  39. Bernstein M, Laperriere N, Glen J (1995) Stereotactic high-activity brachytherapy for malignant intra-axial brain tumors. Status report as of March, 1995. Stereotact Funct Neurosurg 65(1–4):167–170

    Article  PubMed  CAS  Google Scholar 

  40. Malkin MG (1994) Interstitial brachytherapy of malignant gliomas: the Memorial Sloan-Kettering Cancer Center experience. Recent Results Cancer Res 135:117–125

    Article  PubMed  CAS  Google Scholar 

  41. Gutin PH, Phillips TL, Wara WM, Leibel SA, Hosobuchi Y, Levin VA, Weaver KA, Lamb S (1984) Brachytherapy of recurrent malignant brain tumors with removable high-activity iodine-125 sources. J Neurosurg 60(1):61–68

    Article  PubMed  CAS  Google Scholar 

  42. 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(1):39–46

    Article  PubMed  CAS  Google Scholar 

  43. Schnell O, Scholler K, Ruge M, Siefert A, Tonn JC, Kreth FW (2008) Surgical resection plus stereotactic 125I brachytherapy in adult patients with eloquently located supratentorial WHO grade II glioma—feasibility and outcome of a combined local treatment concept. J Neurol 255(10):1495–1502

    Article  PubMed  CAS  Google Scholar 

  44. Korinthenberg R, Neuburger D, Trippel M, Ostertag C, Nikkhah G (2011) Long-term results of brachytherapy with temporary iodine-125 seeds in children with low-grade gliomas. Int J Radiat Oncol Biol Phys 79(4):1131–1138

    Article  PubMed  Google Scholar 

  45. Kreth FW, Warnke PC, Ostertag CB (1993) Interstitial radiosurgery of low grade glioma. Nervenarzt 64(10):633–639

    PubMed  CAS  Google Scholar 

  46. Ostertag CB, Kreth FW (1992) Iodine-125 interstitial irradiation for cerebral gliomas. Acta Neurochir (Wien) 119(1–4):53–61

    Article  CAS  Google Scholar 

  47. Ostertag CB (1989) Stereotactic interstitial radiotherapy for brain tumors. J Neurosurg Sci 33(1):83–89

    PubMed  CAS  Google Scholar 

  48. Kreth FW, Mehrkens JH (2010) Stereotactic brachytherapy in low-grade gliomas. In: Tonn J-C, Westphal M, Rutka JT (eds) Oncology of CNS tumors. Springer, Heidelberg, pp 135–145. doi:10.1007/978-3-642-02874-8_6

    Chapter  Google Scholar 

  49. Laperriere N, Zuraw L, Cairncross G (2002) Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 64(3):259–273

    Article  PubMed  Google Scholar 

  50. Sneed PK, McDermott MW, Gutin PH (1997) Interstitial brachytherapy procedures for brain tumors. Semin Surg Oncol 13(3):157–166

    Article  PubMed  CAS  Google Scholar 

  51. Bernstein M, Gutin PH (1981) Interstitial irradiation of brain tumors: a review. Neurosurgery 9(6):741–750

    Article  PubMed  CAS  Google Scholar 

  52. Kreth FW, Faist M, Warnke PC, Rossner R, Volk B, Ostertag CB (1995) Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82(3):418–429

    Article  PubMed  CAS  Google Scholar 

  53. Ronghe M, Hargrave D, Bartels U, Tabori U, Vaidya S, Chandler C, Kulkarni A, Bouffet E (2010) Vincristine and carboplatin chemotherapy for unresectable and/or recurrent low-grade astrocytoma of the brainstem. Pediatr Blood Cancer 55(3):471–477

    Article  PubMed  Google Scholar 

  54. Marcus KJ, Goumnerova L, Billett AL, Lavally B, Scott RM, Bishop K, Xu R, Young Poussaint T, Kieran M, Kooy H, Pomeroy SL, Tarbell NJ (2005) Stereotactic radiotherapy for localized low-grade gliomas in children: final results of a prospective trial. Int J Radiat Oncol Biol Phys 61(2):374–379

    Article  PubMed  Google Scholar 

  55. Gnekow AK, Kortmann RD, Pietsch T, Emser A (2004) Low grade chiasmatic-hypothalamic glioma-carboplatin and vincristin chemotherapy effectively defers radiotherapy within a comprehensive treatment strategy—report from the multicenter treatment study for children and adolescents with a low grade glioma—HIT-LGG 1996—of the Society of Pediatric Oncology and Hematology (GPOH). Klin Padiatr 216(6):331–342

    Article  PubMed  CAS  Google Scholar 

  56. Merchant TE, Zhu Y, Thompson SJ, Sontag MR, Heideman RL, Kun LE (2002) Preliminary results from a phase II trail of conformal radiation therapy for pediatric patients with localised low-grade astrocytoma and ependymoma. Int J Radiat Oncol Biol Phys 52(2):325–332

    Article  PubMed  Google Scholar 

  57. Saran FH, Baumert BG, Khoo VS, Adams EJ, Garre ML, Warrington AP, Brada M (2002) Stereotactically guided conformal radiotherapy for progressive low-grade gliomas of childhood. Int J Radiat Oncol Biol Phys 53(1):43–51

    Article  PubMed  Google Scholar 

  58. Fisher BJ, Bauman GS, Leighton CE, Stitt L, Cairncross JG, Macdonald DR (1998) Low-grade gliomas in children: tumor volume response to radiation. J Neurosurg 88(6):969–974

    Article  PubMed  CAS  Google Scholar 

  59. Di Pinto M, Conklin HM, Li C, Xiong X, Merchant TE (2010) Investigating verbal and visual auditory learning after conformal radiation therapy for childhood ependymoma. Int J Radiat Oncol Biol Phys 77(4):1002–1008

    Article  PubMed  Google Scholar 

  60. Packer RJ, Ater J, Allen J, Phillips P, Geyer R, Nicholson HS, Jakacki R, Kurczynski E, Needle M, Finlay J, Reaman G, Boyett JM (1997) Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas. J Neurosurg 86(5):747–754

    Article  PubMed  CAS  Google Scholar 

  61. Walter AW, Gajjar A, Reardon DA, Thompson SJ, Langston JW, Jones-Wallace D, Kun LE, Heideman RL (2000) Tamoxifen and carboplatin for children with low-grade gliomas: a pilot study at St. Jude Children’s Research Hospital. J Pediatr Hematol Oncol 22(3):247–251

    Article  PubMed  CAS  Google Scholar 

  62. Gururangan S, Cavazos CM, Ashley D, Herndon JE 2nd, Bruggers CS, Moghrabi A, Scarcella DL, Watral M, Tourt-Uhlig S, Reardon D, Friedman HS (2002) Phase II study of carboplatin in children with progressive low-grade gliomas. J Clin Oncol 20(13):2951–2958

    Article  PubMed  CAS  Google Scholar 

  63. Massimino M, Spreafico F, Cefalo G, Riccardi R, Tesoro-Tess JD, Gandola L, Riva D, Ruggiero A, Valentini L, Mazza E, Genitori L, Di Rocco C, Navarria P, Casanova M, Ferrari A, Luksch R, Terenziani M, Balestrini MR, Colosimo C, Fossati-Bellani F (2002) High response rate to cisplatin/etoposide regimen in childhood low-grade glioma. J Clin Oncol 20(20):4209–4216

    Article  PubMed  CAS  Google Scholar 

  64. Khaw SL, Coleman LT, Downie PA, Heath JA, Ashley DM (2007) Temozolomide in pediatric low-grade glioma. Pediatr Blood Cancer 49(6):808–811

    Article  PubMed  Google Scholar 

  65. Lafay-Cousin L, Sung L, Carret AS, Hukin J, Wilson B, Johnston DL, Zelcer S, Silva M, Odame I, Mpofu C, Strother D, Bouffet E (2008) Carboplatin hypersensitivity reaction in pediatric patients with low-grade glioma: a Canadian Pediatric Brain Tumor Consortium experience. Cancer 112(4):892–899

    Article  PubMed  CAS  Google Scholar 

  66. Packer RJ, Lange B, Ater J, Nicholson HS, Allen J, Walker R, Prados M, Jakacki R, Reaman G, Needles MN et al (1993) Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol 11(5):850–856

    PubMed  CAS  Google Scholar 

  67. Pons MA, Finlay JL, Walker RW, Puccetti D, Packer RJ, McElwain M (1992) Chemotherapy with vincristine (VCR) and etoposide (VP-16) in children with low-grade astrocytoma. J Neurooncol 14(2):151–158

    Article  PubMed  CAS  Google Scholar 

  68. Yen CP, Sheehan J, Steiner M, Patterson G, Steiner L (2007) Gamma knife surgery for focal brainstem gliomas. J Neurosurg 106(1):8–17

    Article  PubMed  Google Scholar 

  69. Fuchs I, Kreil W, Sutter B, Papaethymiou G, Pendl G (2002) Gamma knife radiosurgery of brainstem gliomas. Acta Neurochir Suppl 84:85–90

    PubMed  CAS  Google Scholar 

  70. Hirato M, Nakamura M, Inoue HK, Ohye C, Hirato J, Shibazaki T, Andou Y (1995) Gamma knife radiosurgery for the treatment of brainstem tumors. Stereotact Funct Neurosurg 64(Suppl 1):32–41

    PubMed  Google Scholar 

  71. Kihlstrom L, Lindquist C, Lindquist M, Karlsson B (1994) Stereotactic radiosurgery for tectal low-grade gliomas. Acta Neurochir Suppl 62:55–57

    Article  PubMed  CAS  Google Scholar 

  72. Liao CH, Pan DH, Yang HC, Wu HM, Ho DM, Wong TT, Shih YH (2012) Gamma knife radiosurgery as a treatment modality for low-grade pediatric brainstem gliomas: report of two cases. Childs Nerv Syst 28(1):175–178

    Article  PubMed  Google Scholar 

  73. Hubbell JH, Seltzer SM (1995) Tables of X-ray mass attenuation coefficients and mass energy-absorption coefficients 1 keV to 20 MeV for elements Z = 1 to 92 and 48 additional substances of dosimetric interest. Technical Report NISTIR 5632. NIST, Gaithersburg p 20899

  74. Viola A, Major T, Julow J (2006) Comparison of (125)I stereotactic brachytherapy and LINAC radiosurgery modalities based on physical dose distribution and radiobiological efficacy. Radiat Res 165(6):695–702

    Article  PubMed  CAS  Google Scholar 

  75. 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(2):202–209

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Straße 62 Main Clinic Building 11th Floor, 50937, Cologne, Germany

    Maximilian I. Ruge, Philipp Kickingereder, Harald Treuer & Volker Sturm

  2. Department of Pediatric Hematology and Oncology, University Hospital of Cologne, Cologne, Germany

    Thorsten Simon

Authors
  1. Maximilian I. Ruge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Kickingereder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thorsten Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harald Treuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Volker Sturm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maximilian I. Ruge.

Additional information

Maximilian Ingolf Ruge and Philipp Kickingereder contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruge, M.I., Kickingereder, P., Simon, T. et al. Stereotactic iodine-125 brachytherapy for treatment of inoperable focal brainstem gliomas of WHO grades I and II: feasibility and long-term outcome. J Neurooncol 109, 273–283 (2012). https://doi.org/10.1007/s11060-012-0889-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-012-0889-1

Keywords

Search

Navigation