Brachytherapy as an Adjuvant for Recurrent Atypical and Malignant Meningiomas

Neurosurgery. 2019 Nov 1;85(5):E910-E916. doi: 10.1093/neuros/nyz115.


Background: Recurrent atypical and malignant meningiomas have poor outcomes with surgical therapy alone. Neither adjuvant chemotherapy nor postoperative radiation therapy remedies this problem.

Objective: To evaluate our experience with the treatment of 15 patients treated with I-125 or Cs-131 brachytherapy radiation seeds as an adjuvant in these difficult cases.

Methods: Patients with high-grade recurrent meningioma who underwent resection and intraoperative placement of brachytherapy seeds at our institution from 2002 to 2014 were identified and studied by retrospective chart review.

Results: Fifteen patients with median age of 68.8 yr were treated with I-125 (n = 13) or Cs-131 (n = 2) brachytherapy seeds for cases of recurrent, grade II (n = 8), or grade III (n = 7) meningioma at our institution from 2002 to 2014. These lesions originated from a variety of locations including, convexity (3), falcine (3), frontal (2), occipital (1), parietal (2), 2 sphenoid wing (2), and temporal (2), based recurrent meningiomas. Patients had a median of 2 prior open surgical interventions and received local radiation therapy with a median dose of 55 Gy prior to brachytherapy. Survival at 2.5 yr was 56% for grade II and 17% for grade III lesions. Survival was significantly associated with patient age but not tumoral pathology. Forty percent of patients required reoperations for wound complications following brachytherapy.

Conclusion: Brachytherapy with implantation of permanent radiation seeds provides a viable alternative treatment for recurrent meningioma while carrying a significant clinical risk of wound infection and need for reoperation.

Keywords: Atypical meningioma; Brachytherapy; Malignant meningioma; Radiation therapy; Radiosurgery.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / methods*
  • Brain Neoplasms / radiotherapy*
  • Brain Neoplasms / surgery
  • Cesium Radioisotopes
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Iodine Radioisotopes
  • Male
  • Meningioma / radiotherapy*
  • Meningioma / surgery
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Radiotherapy, Adjuvant / methods
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome


  • Cesium Radioisotopes
  • Iodine Radioisotopes
  • Cesium-131
  • Iodine-125