J Neurosurg 145:206–213, 2026
This prospective single-center phase 2 trial evaluates maximal safe resection combined with intraoperative Cs-131 collagen tile brachytherapy (R+CTBT) for 29 recurrent, aggressive meningiomas, reporting improved local control rates at long-term follow-up compared with each tumor’s prior same-site treatment. Outcomes include Kaplan–Meier local control at 36–60 months, hazard ratios from Cox models, and detailed adverse-event reporting.
The report describes patient selection, implant technique, dosimetry metrics, statistical methods, and safety considerations, highlighting a lower symptomatic radiation necrosis rate with Cs-131 tiles and acceptable surgical complications, while noting single-center design and limited sample size as study limitations.
Objective Evaluate whether maximal safe resection plus Cs-131 collagen tile brachytherapy (R+CTBT) improves control of recurrent aggressive meningiomas versus the patient’s prior same-site treatment.
Design Prospective, nonrandomized, single-center phase 2 trial enrolling patients with recurrent aggressive meningiomas (June 2013–Jan 2018), with follow-up through August 2020.
Procedure After maximal safe resection and intraoperative pathologic confirmation, Cs-131 seeds were embedded into collagen squares (“tiles”) and placed in the resection bed; postoperative CT was used for radiation planning and MRI for extent of resection assessment.
Population 29 tumors in 27 patients (median age 66); tumors at time of R+CTBT were predominantly WHO grade 2 (90%), with 3% grade 1 and 7% grade 3.
Efficacy Local control at 48 and 60 months was 73% and 48% after R+CTBT versus 21% and 17% after prior same-site treatment (HR 0.145, p < 0.001).
Outcomes detail Local progression (≤ 1.5 cm from operative bed) occurred in 8/29 (28%) implant sites over a median radiographic follow-up of 34.8 months.
Complications Surgery-related complications requiring intervention occurred in 4/29 (14%) (1 early infection; 3 delayed wound breakdown/infection).
Radiation injury Symptomatic radiation brain injury/radiation necrosis occurred in 4/29 (14%), and all cases resolved with medical therapy.
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