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Stereotactic radiosurgery (SRS) for patients with brainstem cerebral cavernous malformations (CCMs): an international, multicentric study

S. Dayawansa, C. Dumot, G. Mantziaris, Z. Xu, S. Pikis, S. Peker, Y. Samanci, GD. Ardor, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdelkarim, AMN. El-Shehaby, RME. Eldin, AH. Elazzazi, NM. Moreno, RM. Álvarez, R. Liscak, J. May, D. Mathieu, JN....

. 2024 ; 14 (1) : 25933. [pub] 20241029

Jazyk angličtina Země Anglie, Velká Británie

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc25003775

Brainstem cerebral cavernous malformations (CCM) are clinically more aggressive compared to superficial CCMs. Due to their location, resection can be challenging, making stereotactic radiosurgery (SRS) an attractive alternative for symptomatic patient. Brainstem CCM patients (n = 170) were treated with Gamma Knife SRS at 11 radiosurgical centers. Hemorrhagic risk reduction, risk factors of post-SRS hemorrhage, and clinical outcomes were retrospectively analyzed. Most patients had a single (165/170 patients) brainstem CCMs treated; the majority of CCMs (165/181) presented with bleeding. Single-session SRS decreased the risk of repeat hemorrhage in patients with hemorrhagic brainstem CCM (HR: 0.17, p < 0.001) using recurrent multivariate analysis. The annual hemorrhage rate decreased from 14.8 per 100 CCM-years before SRS to 2.3 after treatment. Using univariate Cox-analysis, the probability of a new hemorrhages after SRS was reduced for patient older than 35 years (HR = 0.21, p = 0.002) and increased with a margin dose > 13 Gy (HR = 2.57, p = 0.044). Adverse radiation effect (ARE) occurred in 9 patients (5.3%) and was symptomatic in four (2.4%). At a median follow-up of 3.4 years (Inter-quartile range: 5.4), 13 patients (8.0%) had a worsened clinical status, with the treated CCM being the cause in 5.6% (10) of the patients. Single-session SRS decreased the risk of repeat hemorrhage in patients with hemorrhagic brainstem CCM and conveyed this benefit with a low risk of advrse radiation effects (ARE) and worsening clinical status.

Department of Clinical Oncology Ain Shams University Cairo Egypt

Department of Neurological Surgery Hospices Civils de Lyon Lyon France

Department of Neurological Surgery University of Virginia Box 800212 Charlottesville VA 22908 USA

Department of Neurosurgery Ain Shams University Cairo Egypt

Department of Neurosurgery and Department of Oncology University of Alberta Edmonton AB Canada

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery NYU Langone New York City NY USA

Department of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Neurosurgery Scientific Institute for Research Hospitalization and Healthcare IRCCS Humanitas Research Hospital Milan Italy

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiation Therapy Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Radiosurgery Rúber Internacional Hospital Madrid Spain

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Division of Neurosurgery Université de Sherbrooke Centre de Recherche du CHUS Sherbrooke QC Canada

Division of Radiation Oncology Department of Oncology University of Alberta Edmonton AB Canada

Dominican Gamma Knife Center and Radiology Department CEDIMAT Santo Domingo Dominican Republic

Extended Modular Program Faculty of Medicine Ain Shams University Cairo Egypt

Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt

Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati OH USA

Neurosurgery Department Faculty of Medicine Benha University Qalubya Egypt

Citace poskytuje Crossref.org

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$a Brainstem cerebral cavernous malformations (CCM) are clinically more aggressive compared to superficial CCMs. Due to their location, resection can be challenging, making stereotactic radiosurgery (SRS) an attractive alternative for symptomatic patient. Brainstem CCM patients (n = 170) were treated with Gamma Knife SRS at 11 radiosurgical centers. Hemorrhagic risk reduction, risk factors of post-SRS hemorrhage, and clinical outcomes were retrospectively analyzed. Most patients had a single (165/170 patients) brainstem CCMs treated; the majority of CCMs (165/181) presented with bleeding. Single-session SRS decreased the risk of repeat hemorrhage in patients with hemorrhagic brainstem CCM (HR: 0.17, p < 0.001) using recurrent multivariate analysis. The annual hemorrhage rate decreased from 14.8 per 100 CCM-years before SRS to 2.3 after treatment. Using univariate Cox-analysis, the probability of a new hemorrhages after SRS was reduced for patient older than 35 years (HR = 0.21, p = 0.002) and increased with a margin dose > 13 Gy (HR = 2.57, p = 0.044). Adverse radiation effect (ARE) occurred in 9 patients (5.3%) and was symptomatic in four (2.4%). At a median follow-up of 3.4 years (Inter-quartile range: 5.4), 13 patients (8.0%) had a worsened clinical status, with the treated CCM being the cause in 5.6% (10) of the patients. Single-session SRS decreased the risk of repeat hemorrhage in patients with hemorrhagic brainstem CCM and conveyed this benefit with a low risk of advrse radiation effects (ARE) and worsening clinical status.
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