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Adverse radiation effects in volume-staged radiosurgery for large arteriovenous malformations: a multiinstitutional study

ZA. Seymour, JW. Chan, MW. McDermott, I. Grills, H. Ye, H. Kano, CA. Lehocky, RC. Jacobs, LD. Lunsford, T. Chytka, R. Liščák, CC. Lee, HC. Yang, D. Ding, JP. Sheehan, CE. Feliciano, R. Rodriguez-Mercado, VL. Chiang, JA. Hess, S. Sommaruga, B....

. 2022 ; 136 (2) : 503-511. [pub] 20210827

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc22019684

OBJECTIVE: The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). METHODS: This is a multicentered 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. The authors evaluated permanent, transient, and total ARE events that were symptomatic. RESULTS: Patients received 2-4 total volume stages. The median age was 33 years at the time of the first SRS volume stage, and the median follow-up was 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cm3 (range 7.7-94.4 cm3), with a median margin dose per stage of 17 Gy (range 12-20 Gy). A total of 64 patients (25%) experienced an ARE, of which 19 were permanent. Rather than volume, maximal linear dimension in the Z (craniocaudal) dimension was associated with toxicity; a threshold length of 3.28 cm was associated with an ARE, with a 72.5% sensitivity and a 58.3% specificity. In addition, parietal lobe involvement for superficial lesions and temporal lobe involvement for deep lesions were associated with an ARE. CONCLUSIONS: Size remains the dominant predictor of toxicity following SRS, but overall rates of AREs were lower than anticipated based on baseline features, suggesting that dose and size were relatively dissociated through volume staging. Further techniques need to be assessed to optimize outcomes.

Citace poskytuje Crossref.org

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$a OBJECTIVE: The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). METHODS: This is a multicentered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM, with volume stages separated by intervals of 3-6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. The authors evaluated permanent, transient, and total ARE events that were symptomatic. RESULTS: Patients received 2-4 total volume stages. The median age was 33 years at the time of the first SRS volume stage, and the median follow-up was 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cm3 (range 7.7-94.4 cm3), with a median margin dose per stage of 17 Gy (range 12-20 Gy). A total of 64 patients (25%) experienced an ARE, of which 19 were permanent. Rather than volume, maximal linear dimension in the Z (craniocaudal) dimension was associated with toxicity; a threshold length of 3.28 cm was associated with an ARE, with a 72.5% sensitivity and a 58.3% specificity. In addition, parietal lobe involvement for superficial lesions and temporal lobe involvement for deep lesions were associated with an ARE. CONCLUSIONS: Size remains the dominant predictor of toxicity following SRS, but overall rates of AREs were lower than anticipated based on baseline features, suggesting that dose and size were relatively dissociated through volume staging. Further techniques need to be assessed to optimize outcomes.
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$a Chan, Jason W $u 2Department of Radiation Oncology, University of California, San Francisco, California
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$a McDermott, Michael W $u 3Department of Neurological Surgery, Miami Neuroscience Institute, Miami, Florida
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$a Grills, Inga $u 1Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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$a Ye, Hong $u 1Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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$a Kano, Hideyuki $u 4Department of Neurosurgery, University of Pittsburgh
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$a Lehocky, Craig A $u 4Department of Neurosurgery, University of Pittsburgh
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$a Jacobs, Rachel C $u 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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$a Lunsford, L Dade $u 4Department of Neurosurgery, University of Pittsburgh
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$a Chytka, Tomas $u 6Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Liščák, Roman $u 6Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Lee, Cheng-Chia $u 7Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
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$a Yang, Huai-Che $u 7Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
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$a Ding, Dale $u 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
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$a Sheehan, Jason P $u 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
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$a Feliciano, Caleb E $u 9Department of Neurosurgery, University of Puerto Rico, San Juan, Puerto Rico
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$a Rodriguez-Mercado, Rafael $u 9Department of Neurosurgery, University of Puerto Rico, San Juan, Puerto Rico
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$a Chiang, Veronica L $u 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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$a Hess, Judith A $u 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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$a Sommaruga, Samuel $u 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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$a McShane, Brendan $u 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
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$a Lee, John Y K $u 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
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$a Vasas, Lucas T $u 12Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
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$a Kaufmann, Anthony M $u 12Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
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$a Sneed, Penny K $u 2Department of Radiation Oncology, University of California, San Francisco, California
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