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Novel Permanent Interstitial Implant for Recurrent Malignancies of the Skull Base

By: Sarah Campen, PharmD
Posted: Tuesday, April 30, 2019

Treating patients with recurrent nasopharyngeal carcinoma of the skull base can be challenging due to a lack of treatment options and potential for damage to surrounding structures. Adam Luginbuhl, MD, of Thomas Jefferson University, Philadelphia, and colleagues described the first known cases of cesium-131 interstitial brachytherapy used to treat this type of malignancy. Their case report highlighting this novel approach in two patients was published in the Journal of Neurological Surgery Reports.

Both patients were initially treated for nasopharyngeal carcinoma of the skull base with adjuvant chemoradiotherapy using intensity-modulated radiation therapy. Three years after initial therapy for an erosive, stage IIIb nasopharyngeal mass, the first patient presented with local recurrence and underwent endoscopic nasopharyngectomy with reconstruction. Four months later, imaging revealed that the 65-year-old man also had a recurrent lobulated tissue mass in the skull base. Surgical resection and interstitial brachytherapy with cesium-131 intraoperative implants were performed.

The second patient, a 34-year-old man, initially presented with a large stage III nasopharyngeal mass. Four months after the completion of combined chemoradiation and sequential adjuvant chemotherapy with cisplatinum, a biopsy revealed that persistent swelling in the right superior nasopharynx was a cancerous mass. After surgical resection involving an endoscopic transnasal approach and confirmation of negative margins, cesium-131 seeds were implanted.

The first patient is currently 9 months out from surgery, with no evidence of metabolically active metastasis or recurrent disease. The second patient is currently being followed with serial imaging and physical exams and also has no evidence of recurrence. No treatment-related complications were reported by either patient.

“The dosimetric properties of cesium-131 […] make it ideally suited for [interstitial brachytherapy] at the skull base, significantly reducing the radiation dose to the surrounding critical normal structures, and the risk of radiation-related side effects,” concluded the clinicians.

Disclosure: The study authors reported no conflicts of interest.

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