Jenö Julow

Publications (9)6.83 Total impact

• Article: Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas.

  Jenö Julow, Erik-Olof Backlund, Ferenc Lányi, Márta Hajda, Katalin Bálint, István Nyáry, György T Szeifert
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  ABSTRACT: Data were analyzed to assess the value of stereotactically applied intracystic colloidal yttrium-90 (YTx) for the treatment of recurrent cystic craniopharyngiomas during a 30-year period. This article compares data from 73 YTx procedures in 60 patients between 1975 and 2006. The cumulative beta dose aimed at the inner surface of the cyst wall was 300 Gy. After YTx, the initial cyst volumes decreased an average of 79%. In 47, the reduction was more than 80%; in 27 of them, the cyst disappeared completely within 1 year. The mean survival after YTx was 9.4 years (range, 0.7-30 yr). Actuarial survival rates at 5, 10, 15, 20, 25, and 30 years were 81, 61, 45, 18, 2, and 0%, respectively. Late complications of YTx were related to the anatomic localization of the cyst, either presellar and retrosellar, e.g., a presellar (prechiasmatic/suprasellar) localization caused neuro-ophthalmological complications in 5.8% and internal carotid artery injury in 1.6%. The treatment of retrosellar (retrochiasmatic, suprasellar) tumors occasionally induced hypothalamic and/or pontomesencephalothalamic damage obviously by untoward radiation to the so-called perforating arteries. This occurred in 3.2% of these latter patients. Despite sporadic complications, intracavitary YTx irradiation is a valuable treatment alternative for craniopharyngioma cysts, sometimes as part of a multimodality management in these tumors, especially in precarious surgical cases.
  Neurosurgery 09/2007; 61(2):288-95; discussion 295-6. · 2.79 Impact Factor
• Article: Tissue response to iodine-125 interstitial brachytherapy of cerebral gliomas.

  Jenö Julow, György T Szeifert, Katalin Bálint, István Nyáry, Zoltán Nemes
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  ABSTRACT: The purpose of this study was to investigate histopathological changes and the role of the microglia/macrophage cell system in the therapeutic effect of iodine-125 (125I) interstitial brachytherapy on cerebral gliomas. Out of a series of 60 cases harboring cerebral astrocytomas and other brain tumors treated with 125I interstitial brachytherapy, autopsy material was available in 10 cases between 0.75 and 60 months after irradiation. The patients were treated with 60-Gy maximum doses at the tumor periphery. Besides the routine HE and Mallory's PTAH trichrome staining, immunohistochemical reactions were carried out for CD15, CD31, CD34, CD45, CD68 (PG-M1), CPM, HAM 56 and HLA-DR antigens to study immunological characteristics of the reactive cell population around gliomas after 125I treatment. The present immunohistochemical study demonstrated that the early lesions following 125I interstitial brachytherapy of gliomas are characterized by migrating macrophages apparently concerned with the removal of necrotic debris. The established phase of reactive zone around the necrotic center disclosed a narrow inner rim of microglial accumulation, and a broad outer area consisting of astrocytic gliosis, vascular proliferation, activated microglia and infiltration by macrophages. In the burned-out phase, the necrosis undergoes liquefaction, the microglial rim is replaced by end-stage macrophages, and the reactive zone is transformed into astrocytic gliosis, which can be considered as equivalent to scar tissue formed around necrosis outside of the central nervous system.
  Progress in neurological surgery 02/2007; 20:312-23.
• Article: Stereotactic intracavitary irradiation of cystic craniopharyngiomas with yttrium-90 isotope.

  Jenö Julow, Ferenc Lányi, Márta Hajda, György T Szeifert, Arpád Viola, Katalin Bálint, István Nyáry
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  ABSTRACT: The authors analyzed data from nearly 30-year follow-up period to assess the value of intracavitary irradiation with stereotactically implanted beta-emitting radioisotope yttrium- 90 (90Y) silicate colloid for the treatment of cystic craniopharyngiomas. Seventy-three cysts in 60 patients were selected for retrospective analysis. The cumulative dose aimed at the inner surface of the cyst wall was 300 Gy. An average of 79% (mean 88.3%) shrinkage of the initial cyst volume was observed. In 47 cysts, the reduction was more than 80%, and the cyst disappeared totally in 29 out of those 47 cases, usually within a year. Mean survival duration after intracavitary irradiation was 9.4 years. Neuroophthalmological prognosis was only favorable when the optic disc was normal or nearly normal at the time of the treatment. In the presence of preexisting optic atrophy, visual damage proved to be irreversible. The long-term results support the view that intracavitary 90Y irradiation is a noninvasive and effective method for the treatment of craniopharyngioma cysts. Because of the mean penetration pathway of beta irradiation is 3.6mm in the soft tissues (maximum 11 mm) it cannot influence the solid part of the tumor; therefore, the best result can be expected in solitary cysts.
  Progress in neurological surgery 02/2007; 20:289-96.
• Article: Pathological findings in cystic craniopharyngiomas after stereotactic intracavitary irradiation with yttrium-90 isotope.

  György T Szeifert, Katalin Bálint, László Sipos, Mainul H Sarker, Sándor Czirják, Jenö Julow
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  ABSTRACT: Histopathological, ultrastructural and polyacrylamide gel electrophoretic examinations were carried out on biopsy, cyst fluid, surgical pathology and autopsy specimens obtained from 7 cystic craniopharyngioma cases before and after yttrium-90 silicate colloid (90Y) irradiation. Light microscopy revealed that the lining epithelial tumor cell layer of the cyst wall was destroyed, and scar tissue containing large amount of hyaline degenerated collagen bundles replaced it. Proliferative postirradiation vasculopathy was also demonstrated in the cyst wall following 90Y installation. Electrophoretic property of cyst fluid was similar to the normal human serum. Considering that scar tissue has a certain propensity to shrink, the fibrosis in the cyst wall together with destruction of neoplastic epithelium and vascular changes might explain diminished fluid production and cyst volume reduction after 90Y treatment.
  Progress in neurological surgery 02/2007; 20:297-302.
• Article: Image fusion-guided stereotactic iodine-125 interstitial irradiation of inoperable and recurrent gliomas.

  Jenö Julow, Arpád Viola, Katalin Bálint, György T Szeifert
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  ABSTRACT: Between 1996 and 2004, 27 patients with low grade gliomas (WHO grade I-II), 10 patients with WHO grade III gliomas and 6 patients with glioblastoma multiforme (WHO grade IV) were treated with stereotactic brachytherapy using low-dose rate iodine-125 (125I) isotope seeds at the Department of Neurosurgery, St. John's Hospital, Budapest, Hungary. In all 43 cases, brachytherapy was used for surgically inoperable gliomas: in 32 cases for recurrent gliomas and in 11 cases as a primary treatment. Results of this study suggest that 125I brachytherapy for inoperable and recurrent gliomas is an effective method and offers a chance for longer-term survival.
  Progress in neurological surgery 02/2007; 20:303-11.
• Article: Iodine-125 brachytherapy of brain stem tumors.

  Jenö Julow, Arpád Viola, Tibor Major, István Valálik, Sarolta Sági, László Mangel, Beáta R Kovács, Imre Repa, Gábor Bajzik, Takácsi N Zoltán, György Németh
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  ABSTRACT: To report on iodine-125 ((125)I) interstitial irradiation in the treatment of brain stem tumors. Two patients with brain stem tumors were treated with CT- and image fusion-guided (125)I stereotactic brachytherapy. By March 2003, the patients had been followed up for 47 and 13 months, respectively. In case 1, the tumor volume was 1.98 cm(3) on the control CT, indicating a 65.5% shrinkage as compared to a target volume of 5.73 cm3 at the time of brachytherapy. In case 2, shrinkage was more distinct. After irradiation, the cyst volume was 0.16 cm(3) on the control MRI, indicating a 97.4% shrinkage as compared to a target volume of 6.05 cm(3) at the time of brachytherapy, i. e., the metastasis had virtually disappeared. CT- and image fusion-guided (125)I stereotactic brachytherapy can be performed during the biopsy session. The procedure can be well planned dosimetrically and is surgically precise.
  Strahlentherapie und Onkologie 08/2004; 180(7):449-54. · 3.56 Impact Factor
• Article: [Brachytherapy of brainstem tumors].

  Jenö Julow, Arpád Viola, Tibor Major, István Valálik, Sarolta Sági, László Mangel, Rita Beáta Kovács, Imre Repa, Gábor Bajzik, György Németh
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  ABSTRACT: The optimal therapy of brain stem tumours of different histopathology determines the expected length of survival. Authors report 125Iodine interstitial irradiation of brain stem tumours with stereotactic brachytherapy. Two patients having brain stem tumours were suffering from glioma or from metastases of a carcinoma. In Case 1 the tumour volume was 1.98 cm3 at the time of planning interstitial irradiation. The control MRI examination performed at 42 months post-op showed a postirradiation cyst size of 5.73 cm3 indicating 65.5% shrinkage. In Case 2 the shrinkage was more apparent as the tumour volume measured on the control MRI at 8 months post-op was only 0.16 cm3 indicating 97.4% shrinkage of the 6.05 cm3 target volume at the time of brachytherapy with the metastasis practically disappearing. Quick access to histopathological results of the stereotactic intraoperative biopsy made it possible to carry out the 125Iodine stereotactic brachytherapy immediately after the biopsy, resulting in less inconvenience for patients of a second possible intervention. The control MRI scans show significant shrinkage of tumours in both patients. The procedure can be performed as a biopsy. The CT and image fusion guided 125Iodine stereotactic brachytherapy can be well planned dosimetrically and is surgically precise.
  Ideggyógyászati szemle 02/2004; 57(1-2):30-5. · 0.49 Impact Factor
• Article: [Interstitial boost and altered fractionation as novel approaches to dose escalation in the radiotherapy of glioblastoma multiforme].

  László Mangel, Jenö Julow, Tibor Major, János Hável, József Lövey, Arpád Viola, András Somogyi, György Németh
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  ABSTRACT: The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques give the opportunity to elaborate optimal treatment forms for primary brain tumours. The authors examined the effect of two novel dose escalation methods on glioblastoma patients. In nine cases they treated T1 tumours with single HDR-AL boost of 10-12 Gy dose following the conventional fractionated 60 Gy external beam radiotherapy. In fifteen patients with T2-4 tumours an intensified, hypofractionated regimen with 2.25-2.5 Gy daily and 60 Gy total dose was applied. All the treatments were carried out with image-based conformal methods. Majority of patients endured treatments without neurological deterioration. Transient neurotoxiticy was noticed in one and two cases, respectively. The median survival times (MST) were found to be 17 months (range: 9-25) and 12 months (range: 6-38) in the two groups, respectively. With respect to all patients, the MST was 13 months, while this value in the conventional treatment is generally considered to be 9-10 months. All the three patients who survived more than 18 months was treated with temozolamide chemotherapy as well. Based on own experience and current knowledge of authors, it seems reasonable to apply higher biological dose focal radiotherapy and chemotherapy in case of glioblastoma patients with better prognosis. To define the optimal treatment regimens randomised clinical trials should be executed.
  Orvosi Hetilap 03/2003; 144(5):223-9.
• Article: [Movement-activated [15O]-butanol PET scan in patients with Parkinson disease].

  István Valálik, Miklós Emri, Zsolt Lengyel, Jenö Julow, Lajos Trón
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  ABSTRACT: The regional cerebral perfusion has been studied by [15O]-butanol PET in bradykinetic patients with Parkinson's disease. In comparison with the rest condition significantly higher perfusion was detected in the primary sensorimotor cortex, parietal cortex, premotor cortex and supplementary motor area. A decrease of activity was observed in the lateral motor cortex, medial frontal cortex, dorsolateral prefrontal cortex and bilaterally in the head of the caudate nuclei. The method is capable of demonstrating the reorganisation of extrapyramidal movement regulation and the impact of medical and surgical treatment modalities. Based on the results conclusions can be drawn for the modes of action of the different treatment modalities.
  Orvosi Hetilap 06/2002; 143(21 Suppl 3):1325-6.