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Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations

G. Mantziaris, S. Pikis, C. Dumot, S. Dayawansa, R. Liščák, J. May, CC. Lee, HC. Yang, N. Martinez Moreno, R. Martinez Álvarez, LD. Lunsford, A. Niranjan, Z. Wei, P. Srinivasan, LW. Tang, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdelkarim, AMN....

. 2023 ; 54 (8) : 1974-1984. [pub] 20230623

Jazyk angličtina Země Spojené státy americké

Typ dokumentu multicentrická studie, časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc23016688

BACKGROUND: Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation. METHODS: This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome. RESULTS: The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; >4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P<0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P<0.001) were associated with reduced probability of favorable outcome. CONCLUSIONS: Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.

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$a Mantziaris, Georgios $u Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.) $1 https://orcid.org/0000000233898836
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$a Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations / $c G. Mantziaris, S. Pikis, C. Dumot, S. Dayawansa, R. Liščák, J. May, CC. Lee, HC. Yang, N. Martinez Moreno, R. Martinez Álvarez, LD. Lunsford, A. Niranjan, Z. Wei, P. Srinivasan, LW. Tang, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdelkarim, AMN. El-Shehaby, RM. Emad, A. Hesham Elazzazi, S. Peker, Y. Samanci, V. Padmanaban, FJ. Jareczek, J. McInerney, KM. Cockroft, D. Mathieu, S. Aldakhil, JD. Alzate, D. Kondziolka, M. Tripathi, JD. Palmer, R. Upadhyay, M. Lin, G. Zada, C. Yu, CP. Cifarelli, DT. Cifarelli, Z. Xu, JP. Sheehan
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$a BACKGROUND: Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation. METHODS: This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome. RESULTS: The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; >4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P<0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P<0.001) were associated with reduced probability of favorable outcome. CONCLUSIONS: Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.
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$a Dumot, Chloe $u Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.) $1 https://orcid.org/0000000313332533
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$a Dayawansa, Samantha $u Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.) $1 https://orcid.org/0000000225283145
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$a Liščák, Roman $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J.M.) $u Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
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$a May, Jaromir $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J.M.) $1 https://orcid.org/000000019925338X $7 xx0235967
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$a Lee, Cheng-Chia $u Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taiwan (C.-c.L., H.-c.Y.) $u School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-c.L., H.-c.Y.) $1 https://orcid.org/0000000346912913
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$a Yang, Huai-Che $u Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taiwan (C.-c.L., H.-c.Y.) $u School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-c.L., H.-c.Y.) $1 https://orcid.org/0000000249495417
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$a Martinez Moreno, Nuria $u Radiosurgery Unit, Hospital Ruber Internacional, Madrid, Spain (N.M.M., R.M.A.) $1 https://orcid.org/000000032400704X
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$a Martinez Álvarez, Roberto $u Radiosurgery Unit, Hospital Ruber Internacional, Madrid, Spain (N.M.M., R.M.A.)
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$a Lunsford, L Dade
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$a Niranjan, Ajay $u Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
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$a Wei, Zhishuo $u Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
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$a Srinivasan, Priyanka $u Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.) $1 https://orcid.org/0000000160860895
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$a Tang, Lilly W $u Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.) $1 https://orcid.org/0000000151519177
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$a Nabeel, Ahmed M $u Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.) $u Neurosurgery Department, Benha University, Qalubya, Egypt (A.M.N., W.A.R.) $1 https://orcid.org/0000000292178142
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$a Reda, Wael A $u Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.) $u Neurosurgery Department, Benha University, Qalubya, Egypt (A.M.N., W.A.R.)
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$a Tawadros, Sameh R $u Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.) $u Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
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$a Abdelkarim, Khaled $u Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.) $u Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.) $1 https://orcid.org/0000000336290217
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$a El-Shehaby, Amr M N $u Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.) $u Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.) $1 https://orcid.org/0000000290759138
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$a Emad, Reem M $u Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.) $u Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt (R.M.E.)
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$a Hesham Elazzazi, Ahmed $u Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
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$a Peker, Selcuk $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey (S. Peker, Y.S.) $1 https://orcid.org/0000000330573355
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$a Samanci, Yavuz $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey (S. Peker, Y.S.) $1 https://orcid.org/0000000189526866
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$a Padmanaban, Varun $u Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.) $1 https://orcid.org/0000000295387708
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$a Jareczek, Francis J $u Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
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$a McInerney, James $u Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.) $1 https://orcid.org/000000018071369X
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$a Cockroft, Kevin M $u Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.) $1 https://orcid.org/0000000274567507
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$a Mathieu, David $u Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada (D.M., S.A.) $1 https://orcid.org/0000000320296315
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$a Aldakhil, Salman $u Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada (D.M., S.A.) $1 https://orcid.org/000000017560435X
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$a Alzate, Juan Diego $u Department of Neurosurgery, NYU Langone, NY (J.D.A. D.K.) $1 https://orcid.org/0000000156638722
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$a Kondziolka, Douglas $u Department of Neurosurgery, NYU Langone, NY (J.D.A. D.K.)
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$a Tripathi, Manjul $u Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India (M.T.) $1 https://orcid.org/0000000256793439
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$a Palmer, Joshua D $u Department of Radiation Oncology, The James Comprehensive Cancer Center Ohio State University, Columbus (J.D.P., R.U.)
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$a Upadhyay, Rituraj $u Department of Radiation Oncology, The James Comprehensive Cancer Center Ohio State University, Columbus (J.D.P., R.U.) $1 https://orcid.org/0000000340791268
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$a Lin, Michelle $u Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
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$a Zada, Gabriel $u Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
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$a Yu, Cheng $u Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
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$a Cifarelli, Christopher P $u Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown (C.P.C., D.T.C.) $1 https://orcid.org/0000000231472743
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$a Cifarelli, Daniel T $u Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown (C.P.C., D.T.C.)
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