Objective: To present long- term results after interstitial iodine125 irradiation of adult patients with de- novo World Health Organization (WHO) Grade II astrocytomas and oligoastrocytomas of the insula of Reil with special respect to the treatment- related risk. Methods: 55 consecutively treated patients (from 1979 to 1992) with circumscribed tumors with a diameter 10 years. 5- year (10- year) progression- free survival was 40.7% (20.2% ), and 5- year (10- year) survival 54.6% (28.4% ). Malignant transformation occurred in 42.4 % after 5 years. Neither of the Kaplan- Meier curves showed a leveling off over time. Transient (progressive) radiogenic complications were observed in 13 [4] patients (one- year overall complication rate: 18% ), and were significantly associated with a tumor diameter > 3.5 cm (p < 0.001). No long term side- effects were detected and delayed external beam irradiation (in case of tumor progression) did not enhance the risk. Tumor enhancement on CT was the only unfavorable predictor for survival. Conclusion: A limited overall prognosis for adult patients with insular WHO grade II astrocytomas and oligoastrocytomas was detected. Interstitial 1- 125 irradiation offers a minimal- invasive and low- risk treatment option for circumscribed tumors with a diameter < 3.5 cm. Larger tumors require further evaluation for optimal treatment.
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