RADT-01 A COMPREHENSIVE REVIEW OF THE UTILITY OF BRACHYTHERAPY IN THE MANAGEMENT OF BRAIN METASTASIS

Abstract PURPOSE This literature review investigates the current applications of brachytherapy in treating brain metastases (BMs), focusing on its advantages, limitations, and clinical outcomes. METHODS A comprehensive literature search was conducted using PubMed, Embase, and ClinicalTrials.gov, focusing on studies related to brachytherapy in BM treatment and adhering to PRISMA guidelines. We included studies if they reported brachytherapy techniques, isotopes, and patient outcomes. RESULTS Our initial search yielded 1,813 articles, of which 42 studies met inclusion criteria reporting on brachytherapy techniques, the isotopes utilized, and patient outcomes. Specifically, we identified 19 total studies assessing the use of Iodine-125 (I-125) brachytherapy, including two prospective studies, 16 retrospective studies, and one case report. There were 23 total studies assessing the use of Cesium-131 (Cs-131) brachytherapy, including five clinical trials, four prospective studies, 11 retrospective studies, and three case reports. Two retrospective studies used both Cs-131 and I-125 seeds. We identified three registered national clinical trials examining the use of Cs-131 brachytherapy for BM treatment. Although I-125 brachytherapy was found to be effective in BM treatment with local control rates and median overall survival paralleling stereotactic radiosurgery and whole brain radiotherapy, the rates of radiation necrosis were as high as 23% in one study. Conversely, Cs-131 studies described high rates of locoregional tumor control with minimal rates of radiation necrosis. One clinical trial found a statistically significant improvement in cognitive functioning and quality of life at four- and six-months following Cs-131 seed implantation. CONCLUSION Brachytherapy, with a particular focus on I-125 and Cs-131 isotopes, has shown promise in treating brain metastases, offering targeted radiation with minimal effects on surrounding healthy tissue. Future research, including randomized controlled trials and long-term follow-up studies, is necessary to optimize the role of brachytherapy in the treatment of brain metastases.