GammaTile, a novel brachytherapy for neurosurgery, debuts at Penn Medicine
GammaTile® brachytherapy has been introduced at Penn Neurosurgery to deliver targeted, immediate irradiation at the brain tumor bed following surgery.
A multi-disciplinary team of neurosurgeons and radiation oncologists at Penn Medicine have introduced GammaTile®, a novel form of brachytherapy for brain tumors, including brain metastases, glioma, and recurrent meningioma. The only available collagen tile brachytherapy, GammaTile was developed to allow for surgical implantation of brachytherapy with excellent sparing of normal brain structures as an enhancement to safety and prevention of tumor recurrence. As such, GammaTile offers an important option that may optimize risk and benefit for select patients with brain tumors.
At Penn Medicine, Christina Jackson, MD, and Emily Lebow, MD, specialize in the complexities of radiotherapy in the wake of brain surgery. Both have gained expertise with GammaTile in practice. As a neurosurgeon, Dr. Jackson performs complex brain surgery. Dr. Lebow is a radiation oncologist whose practice focuses on brain tumors. Both see patients at the Perelman Center for Advanced Medicine in Philadelphia, with Dr. Jackson providing additional outpatient appointments in Radnor, PA.
Addressing the challenges of radiation therapy in brain surgery
Among the advantages of GammaTile is that it eliminates two of the prevailing challenges of post-operative radiation therapy in brain surgery—the time to onset of radiotherapy, and the logistics of care thereafter.
In the context of postoperative radiotherapy, the timing between surgery and the application of radiation is among the tantamount dilemmas of brain surgery. Starting too soon increases the risk of tissue injury during wound healing, a worry for surgeons, Dr. Jackson notes. However, the wait between surgery and the application of radiotherapy runs the risk of proliferation of residual tumor cells.
Once radiation therapy begins, other concerns prevail, Dr Lebow says. For example, patients may require as many as 30 additional trips into the hospital for treatment, a logistical challenge that makes it difficult for some patients to receive optimal, prompt radiation care after surgical resection.
“Patients who receive intraoperative GammaTile get all of their care during surgery,” Dr. Lebow explains, a benefit, she adds, that mitigates the need for subsequent hospital visits.
About GammaTile
Since its FDA approval in 2018, GammaTile has proved an invaluable adjunct to neurosurgery in that it provides immediate, targeted radiation to destroy remaining cancer cells while protecting healthy brain tissue, and reduces the risk of recurrence for glioblastomas, meningiomas, and metastatic brain tumors.
Composed of bioresorbable, conformable collagen tiles embedded with titanium-encapsulated cesium-131 (Cs-131) seeds, GammaTile is used intraoperatively, immediately after tumor resection. Once in place, the tiles provide focused radiation for several weeks, targeting cancer cells while minimizing exposure to healthy brain tissue. The short half-life of Cs-131 (9.7 days) provides a higher initial dose rate and allows the planned dose to occur over a shorter period than other forms of radiotherapy, which may enhance activity versus aggressive brain tumors.
“The beauty of GammaTile is that the radioactive seeds are embedded in a surgical adjunct—collagen—a material very familiar to surgeons,” says Dr. Jackson. Because collagen dissolves over time, the tiles need not be removed.
The seeds are offset in the carrier tiles from both the surface of the tumor cavity and from each other, ensuring dosimetric uniformity and preventing the intense radiation dose that would occur if seeds were implanted in brain tissue.
GammaTile at Penn Medicine
The advent of GammaTile at Penn Medicine brings another option to a wide spectrum of patients with brain tumors, in addition to providing comprehensive care in the OR and biological advantages in controlling disease. GammaTile also contributes to the realization of holistic wellness in patients treated for brain tumors at Penn Neurosciences, a concept central to Penn Medicine’s institutional mission.
Currently, the specialists using GammaTile at Penn Medicine include neurosurgeons Dr. Jackson and Nduka M. Amankulor, MD, with Dr. Lebow and Michelle Alonso-Basanta, MD, PhD, representing Penn Radiation Oncology.
Among the benefits GammaTile brings to Penn Medicine, Dr. Lebow observes, is that it may be combined with a wide range of other therapies a patient may be receiving.
“As long as a patient is well enough to undergo a surgical resection, GammaTile can be combined with any other type of chemotherapy, immunotherapy, or targeted therapy,” she adds. This means that patients who are receiving a wide variety of systemic therapies or other oncologic interventions are eligible for GammaTile.
The follow-up for GammaTile is notable for its lack of exceptional precautions. “The recovery from surgery is really no different from having surgery without GammaTile,” says Dr. Jackson.
Indications for GammaTile
GammaTile is indicated for newly diagnosed malignant brain tumors and recurrent tumors. The breadth of these indications is fortuitous in that it embraces a large spectrum of potential patients.
“Right now, we’re evaluating every patient that we see in clinic for fit for GammaTile,” says Dr. Jackson. “The patients we’re considering include people who have either primary tumors that started in the brain, such as meningioma, or cancers that have spread to the brain from elsewhere in the body, such as a melanoma or breast cancer.”
Among these indications, patients with meningioma form a special subset. Meningiomas are rarely malignant, but their benign status masks their true potential, says Dr. Jackson.
“Some aggressive forms of meningioma can come back despite previous surgery and previous radiation,” she says. “This means that patients’ treatment options are more limited and that repeat external radiation can lead to swelling of the brain and other side effects.” Because recurrence often appears at the periphery of the previous tumor, Dr. Jackson concludes, these patients are amenable to direct local therapy with GammaTile.
What follows, once the patient has been identified, is a tumor board review including Dr. Lebow and her peers in radiation oncology, as well as neurosurgeons and other specialists. “And if everybody agrees as a group that someone is a good candidate, we plan the surgery to include GammaTile,” says Dr. Lebow.
Referrals and consultations
For further information about GammaTile, brain surgery, and radiation oncology at Penn Medicine, please call 877-937-7366, or submit a referral through our secure online referral form.