• Je něco špatně v tomto záznamu ?

Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients

G. Garcia, G. Mantziaris, S. Pikis, C. Dumot, LD. Lunsford, A. Niranjan, Z. Wei, P. Srinivasan, LW. Tang, R. Liscak, J. May, CC. Lee, HC. Yang, S. Peker, Y. Samanci, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdel Karim, AMN. El-Shehaby, R. Emad...

. 2024 ; 33 (4) : 307-314. [pub] 20240126

Jazyk angličtina Země Spojené státy americké

Typ dokumentu multicentrická studie, časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc24014485

OBJECTIVE: The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS: Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation. RESULTS: The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm3, respectively) and second (16.5 mm and 1.6 cm3, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%-7.8%) at 1 year to 44% (95% CI 32%-55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%-62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%-16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed. CONCLUSIONS: The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.

Citace poskytuje Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc24014485
003      
CZ-PrNML
005      
20240905134054.0
007      
ta
008      
240725s2024 xxu f 000 0|eng||
009      
AR
024    7_
$a 10.3171/2023.12.PEDS23465 $2 doi
035    __
$a (PubMed)38277659
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a xxu
100    1_
$a Garcia, Gracie $u 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
245    10
$a Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients / $c G. Garcia, G. Mantziaris, S. Pikis, C. Dumot, LD. Lunsford, A. Niranjan, Z. Wei, P. Srinivasan, LW. Tang, R. Liscak, J. May, CC. Lee, HC. Yang, S. Peker, Y. Samanci, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdel Karim, AMN. El-Shehaby, R. Emad Eldin, AH. Elazzazi, N. Martínez Moreno, R. Martínez Álvarez, V. Padmanaban, FJ. Jareczek, J. McInerney, KM. Cockroft, JD. Alzate, D. Kondziolka, M. Tripathi, JP. Sheehan
520    9_
$a OBJECTIVE: The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS: Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation. RESULTS: The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm3, respectively) and second (16.5 mm and 1.6 cm3, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%-7.8%) at 1 year to 44% (95% CI 32%-55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%-62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%-16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed. CONCLUSIONS: The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.
650    _2
$a lidé $7 D006801
650    _2
$a dítě $7 D002648
650    12
$a radiochirurgie $x škodlivé účinky $x metody $7 D016634
650    _2
$a výsledek terapie $7 D016896
650    _2
$a retrospektivní studie $7 D012189
650    12
$a intrakraniální arteriovenózní malformace $x diagnostické zobrazování $x radioterapie $x komplikace $7 D002538
650    _2
$a krvácení $x komplikace $x chirurgie $7 D006470
650    12
$a cysty $7 D003560
650    _2
$a následné studie $7 D005500
655    _2
$a multicentrická studie $7 D016448
655    _2
$a časopisecké články $7 D016428
700    1_
$a Mantziaris, Georgios $u 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
700    1_
$a Pikis, Stylianos $u 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
700    1_
$a Dumot, Chloe $u 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
700    1_
$a Lunsford, L Dade $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
700    1_
$a Niranjan, Ajay $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
700    1_
$a Wei, Zhishuo $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
700    1_
$a Srinivasan, Priyanka $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
700    1_
$a Tang, Lilly W $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
700    1_
$a Liscak, Roman $u 3Department of Stereotactic and Radiation Neurosurgery, Nemocnice Na Homolce Hospital, Prague, Czech Republic
700    1_
$a May, Jaromir $u 3Department of Stereotactic and Radiation Neurosurgery, Nemocnice Na Homolce Hospital, Prague, Czech Republic
700    1_
$a Lee, Cheng-Chia $u 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan $u 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
700    1_
$a Yang, Huai-Che $u 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan $u 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
700    1_
$a Peker, Selcuk $u 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
700    1_
$a Samanci, Yavuz $u 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
700    1_
$a Nabeel, Ahmed M $u 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt $u 8Neurosurgery Department, Benha University, Qalubiya, Egypt
700    1_
$a Reda, Wael A $u 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt $u 8Neurosurgery Department, Benha University, Qalubiya, Egypt
700    1_
$a Tawadros, Sameh R $u 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt $u 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
700    1_
$a Abdel Karim, Khaled $u 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt $u 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
700    1_
$a El-Shehaby, Amr M N $u 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt $u 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
700    1_
$a Emad Eldin, Reem $u 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt $u 10Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
700    1_
$a Elazzazi, Ahmed Hesham $u 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
700    1_
$a Martínez Moreno, Nuria $u 11Radiosurgery Unit, Hospital Ruber Internacional, Madrid, Spain
700    1_
$a Martínez Álvarez, Roberto $u 11Radiosurgery Unit, Hospital Ruber Internacional, Madrid, Spain
700    1_
$a Padmanaban, Varun $u 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
700    1_
$a Jareczek, Francis J $u 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
700    1_
$a McInerney, James $u 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
700    1_
$a Cockroft, Kevin M $u 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
700    1_
$a Alzate, Juan Diego $u 13Department of Neurosurgery, NYU Langone, New York, New York; and
700    1_
$a Kondziolka, Douglas $u 13Department of Neurosurgery, NYU Langone, New York, New York; and
700    1_
$a Tripathi, Manjul $u 14Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
700    1_
$a Sheehan, Jason P $u 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
773    0_
$w MED00152433 $t Journal of neurosurgery. Pediatrics $x 1933-0715 $g Roč. 33, č. 4 (2024), s. 307-314
856    41
$u https://pubmed.ncbi.nlm.nih.gov/38277659 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y - $z 0
990    __
$a 20240725 $b ABA008
991    __
$a 20240905134047 $b ABA008
999    __
$a ok $b bmc $g 2143939 $s 1226351
BAS    __
$a 3
BAS    __
$a PreBMC-MEDLINE
BMC    __
$a 2024 $b 33 $c 4 $d 307-314 $e 20240126 $i 1933-0715 $m Journal of neurosurgery. Pediatrics $n J Neurosurg Pediatr $x MED00152433
LZP    __
$a Pubmed-20240725

Najít záznam

Citační ukazatele

Pouze přihlášení uživatelé

Možnosti archivace