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Dose response and architecture in volume staged radiosurgery for large arteriovenous malformations: A multi-institutional study

ZA. Seymour, JW. Chan, PK. Sneed, H. Kano, CA. Lehocky, RC. Jacobs, H. Ye, T. Chytka, R. Liscak, CC. Lee, HC. Yang, D. Ding, J. Sheehan, CE. Feliciano, R. Rodriguez-Mercado, VL. Chiang, JA. Hess, S. Sommaruga, B. McShane, J. Lee, LT. Vasas, AM....

. 2020 ; 144 (-) : 180-188. [pub] 20191210

Jazyk angličtina Země Irsko

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc21020731

BACKGROUND: Optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. Volume-staged stereotactic radiosurgery (VS-SRS) provides an effective option for these high-risk lesions, but optimizing treatment for these recalcitrant and rare lesions has proven difficult. METHODS: This is a multi-centered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM with volume stages separated by intervals of 3-6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. We evaluated near complete response (nCR), obliteration, cure, and overall survival. RESULTS: With a median age of 33 years old at the time of first SRS volume stage, patients received 2-4 total volume stages and a median follow up of 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cc (range: 7.7-94.4 cc) with a median margin dose per stage of 17 Gy (range: 12-20 Gy). Total AVM volume, margin dose per stage, compact nidus, lack of prior embolization, and lack of thalamic location involvement were all associated with improved outcomes. Dose >/= 17.5 Gy was strongly associated with improved rates of nCR, obliteration, and cure. With dose >/= 17.5 Gy, 5- and 10-year cure rates were 33.7% and 76.8% in evaluable patients compared to 23.7% and 34.7% of patients with 17 Gy and 6.4% and 20.6% with <17 Gy per volume-stage (p = 0.004). Obliteration rates in diffuse nidus architecture with <17 Gy were particularly poor with none achieving obliteration compared to 32.3% with doses >/= 17 Gy at 5 years (p = 0.007). Comparatively, lesions with a compact nidus architecture exhibited obliteration rates at 5 years were 10.7% vs 9.3% vs 26.6% for dose >17 Gy vs 17 Gy vs >/=17.5 Gy. CONCLUSION: VS-SRS is an option for upfront treatment of large AVMs. Higher dose was associated with improved rates of nCR, obliteration, and cure suggesting that larger volumetric responses may facilitate salvage therapy and optimize the chance for cure.

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$a BACKGROUND: Optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. Volume-staged stereotactic radiosurgery (VS-SRS) provides an effective option for these high-risk lesions, but optimizing treatment for these recalcitrant and rare lesions has proven difficult. METHODS: This is a multi-centered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM with volume stages separated by intervals of 3-6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. We evaluated near complete response (nCR), obliteration, cure, and overall survival. RESULTS: With a median age of 33 years old at the time of first SRS volume stage, patients received 2-4 total volume stages and a median follow up of 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cc (range: 7.7-94.4 cc) with a median margin dose per stage of 17 Gy (range: 12-20 Gy). Total AVM volume, margin dose per stage, compact nidus, lack of prior embolization, and lack of thalamic location involvement were all associated with improved outcomes. Dose >/= 17.5 Gy was strongly associated with improved rates of nCR, obliteration, and cure. With dose >/= 17.5 Gy, 5- and 10-year cure rates were 33.7% and 76.8% in evaluable patients compared to 23.7% and 34.7% of patients with 17 Gy and 6.4% and 20.6% with <17 Gy per volume-stage (p = 0.004). Obliteration rates in diffuse nidus architecture with <17 Gy were particularly poor with none achieving obliteration compared to 32.3% with doses >/= 17 Gy at 5 years (p = 0.007). Comparatively, lesions with a compact nidus architecture exhibited obliteration rates at 5 years were 10.7% vs 9.3% vs 26.6% for dose >17 Gy vs 17 Gy vs >/=17.5 Gy. CONCLUSION: VS-SRS is an option for upfront treatment of large AVMs. Higher dose was associated with improved rates of nCR, obliteration, and cure suggesting that larger volumetric responses may facilitate salvage therapy and optimize the chance for cure.
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$a Chan, Jason W $u University of California - San Francisco School of Medicine, Department of Radiation Oncology, United States
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$a Sneed, Penny K $u University of California - San Francisco School of Medicine, Department of Radiation Oncology, United States
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$a Kano, Hideyuki $u University of Pittsburgh, School of Medicine, Department of Neurosurgery, United States
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$a Lehocky, Craig A $u University of Pittsburgh, School of Medicine, Department of Neurosurgery, United States
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$a Jacobs, Rachel C $u University of Pittsburgh, School of Medicine, Department of Neurosurgery, United States
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$a Ye, Hong $u Beaumont Health, Department of Radiation Oncology, United States
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$a Chytka, Tomas $u Na Homolce Hospital, Department of Stereotactic Radioneurosurgery, Prague, Czech Republic
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$a Liscak, Roman $u Na Homolce Hospital, Department of Stereotactic Radioneurosurgery, Prague, Czech Republic
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$a Lee, Cheng-Chia $u Taipei General Hospital, Department of Neurosurgery, Taiwan
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$a Yang, Huai-Che $u Taipei General Hospital, Department of Neurosurgery, Taiwan
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$a Ding, Dale $u University of Virginia School of Medicine, Department of Neurosurgery, United States
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$a Sheehan, Jason $u University of Virginia School of Medicine, Department of Neurosurgery, United States
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$a Feliciano, Caleb E $u University of Puerto Rico School of Medicine, Department of Neurosurgery, United States
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$a Rodriguez-Mercado, Rafael $u University of Puerto Rico School of Medicine, Department of Neurosurgery, United States
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$a Chiang, Veronica L $u Yale University School of Medicine, Department of Neurosurgery, United States
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$a Hess, Judith A $u Yale University School of Medicine, Department of Neurosurgery, United States
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$a Sommaruga, Samuel $u Yale University School of Medicine, Department of Neurosurgery, United States
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$a McShane, Brendan $u University of Pennsylvania School of Medicine, Department of Neurosurgery, United States
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$a Lee, John $u University of Pennsylvania School of Medicine, Department of Neurosurgery, United States
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$a Vasas, Lucas T $u University of Manitoba School of Medicine, Department of Neurosurgery, Canada
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$a Kaufmann, Anthony M $u University of Manitoba School of Medicine, Department of Neurosurgery, Canada
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$a Grills, Inga $u Beaumont Health, Oakland University William Beaumont School of Medicine, Department of Radiation Oncology, United States
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