A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery

Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade; Pollock, Bruce E.; Yamamoto, Masaaki; Gorman, Deborah A.; Schomberg, Paula J.; Sneed, P.K.; Larson, David A.; Smith, Vernon; McDermott, Michael W.; Miyawaki, Lloyd; Chilton, Jonathan; Morantz, Robert A.; Young, Byron; Jokura, Hidefumi

doi:10.1016/s0360-3016(98)00518-5

Cited by 228 publications

(74 citation statements)

References 15 publications

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“…Some criteria for predicting the risk of ARE after gamma knife radiosurgery have been reported. Several studies have assessed treatment-related factors including the volume of the brain receiving a specific dose, the prescription dose, the number of targets, and the total tumor volume for the development of radiation-related changes [11,12,14,15,16,17,18,31]. Most commonly, a normal brain receiving 10 or 12 Gy has been correlated with radiation toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Most commonly, a normal brain receiving 10 or 12 Gy has been correlated with radiation toxicity. The majority of these reports have been on patients with AVM, not brain tumors [13,16,17,31,32]. Most of the researchers used a 12-Gy peripheral isodose volume as the predictor of radiation-related toxicity [13,19,29].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have assessed the predictive factors for the development of adverse radiation effects (ARE). Patient-related factors have been reported to be: tumor volume, location, previous irradiation, and male gender; treatment-related factors have been reported to be: treatment dose, prescription isodose volume, conformity indices, and the volume of brain receiving a particular dose [2,10,11,12,13,14,15,16,17,18]. More commonly, the volume of brain receiving 12 Gy (V12 Gy) has been recommended to assess treatment toxicity and used to optimize the treatment dose in gamma knife radiosurgery [13,19,20].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating Critical Brain Radiation Doses in the Treatment of Multiple Brain Lesions with Gamma Knife Radiosurgery

Hatiboğlu

Akdur²

2017

Stereotact Funct Neurosurg

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Background: Treatment of patients with multiple brain metastases has shifted to stereotactic radiosurgery, withholding whole-brain (WB) radiation therapy. However, radiation toxicity to the brain is a concern when treating multiple brain lesions with single-fraction stereotactic radiosurgery. Objective: The purpose of this study was todetermine the changes in brain radiation doses when treating various numbers of targets and lesion volumes. Methods: We simulated different treatment plans with different combinations of varying tumor volumes including 0.1, 0.5, 1, 2, and 5 cm³, and tumor numbers including 1, 3, 5, 10, 15, 20, and 25. Treatment planning was performed for all combinations in a computerized tomography of the head of a patient, using Leksell GammaPlan version 10.1.1 (Elekta AB, Stockholm, Sweden). Two different dosing strategies were used. In the lower-prescription dosing schedule, a marginal dose was given to the 50% isodose line, and 20 Gy were used when the number of lesions was less than 15 and 18 Gy were applied when the number of lesions was equal to or more than 15. In the higher-prescription dosing schedule, a marginal dose of 24 Gy was used for lesions of less than 5 cm³ and 20 Gy were applied for lesions equal to 5cm³. The mean WB dose, the WB integral dose, and the volume of brain receiving 12 Gy (V12 Gy) were calculated for each scenario. Also, the beam-on time of the Gamma Knife 4C unit was reported for all treatment scenarios. Results: Regression analysis showed that the total tumor volume was a more significant predictor of V12 Gy than the number of lesions, and a linear correlation between the total tumor volume and V12 Gy was found. We also found that the total tumor volume was a more significant predictor of the mean WB dose and the WB integral dose compared to the number of lesions. Conclusion: Our results suggest that multiple small to mid-sized lesions could be safely treated with a single-fraction gamma knife.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating Critical Brain Radiation Doses in the Treatment of Multiple Brain Lesions with Gamma Knife Radiosurgery

Hatiboğlu

Akdur²

2017

Stereotact Funct Neurosurg

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“…• Early complications of radiosurgery are relatively rare. However, late neurologic complications, most commonly from late radiation-induced injury to functioning brain, occur with higher frequency (8% in one large retrospective multicenter series) [37]. Symptoms resolved completely in about half of these cases.…”

Section: Radiosurgerymentioning

confidence: 96%

Arteriovenous malformations in the brain

Graham

2002

Curr Treat Options Neurol

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Arteriovenous malformations (AVM) are a leading cause of intracerebral hemorrhage, especially among the young. Because they pose a lifelong risk of serious bleeding, definitive treatment to obliterate the AVM should be pursued in the majority of patients. Microsurgical resection of a small AVM located in the superficial or non- eloquent brain achieves high cure rates with low morbidity, and is the recommended choice for such lesions. Radiosurgery with gamma knife, linear accelerator, or heavy ion beam irradiation is an alternative therapy for AVM treatments less than 3 centimeters in diameter located in brain regions where surgery is likely to produce major neurologic deficits, or for patients unable or unwilling to undergo craniotomy and resection. Cure rates are lower than with microsurgery, and obliteration of the lesion may take 2 to 3 years, during which time the patient remains at risk for hemorrhage. Because rates of recurrent hemorrhage are higher than rates of initial bleeding, radiosurgery may be a good option for patients who have not yet had an intracranial hemorrhage. Endovascular embolization as sole therapy is curative only in a small percentage of cases, but is recommended as part of a multimodal approach to reduce the size of a large AVM, and decrease bleeding risk of lesions with multiple or inaccessible feeding vessels or associated aneurysms prior to surgery or radiotherapy. Currently, treatment decisions must rely solely on Class III evidence from case series and expert opinion. Randomized clinical trials are needed to provide objective guidelines for the future management of patients with an AVM.

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“…However, for large AVMs (greater than 3 cm in diameter) there is a significantly lower chance of obliteration [21] and an increasing risk of complications. In a study of long-term complications after stereotactic radiosurgery suffered by 102 out of 1255 AVM patients from combined institutions [22], the majority (nearly 80%) were associated with radiation injury to the brain. There were significantly less symptoms in patients with no history of prior hemorrhage (66% vs 41%) and in patients whose only sequelae of radiosurgery was minimal headache or seizure as (88% vs 34%).…”

Section: Arteriovenous Malformationsmentioning

confidence: 99%

Advances in stereotactic radiosurgery for brain neoplasms

M¹

2001

Curr Neurol Neurosci Rep

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It has been nearly half a century since Leksell introduced brain radiosurgery. In the past decade, the procedure has become widely used as both a primary and adjuvant treatment. Radiosurgery is now commonly employed for arteriovenous malformations, brain metastases, and several benign lesions. Its use in primary brain malignancy remains of uncertain benefit. Improvements in imaging, hardware, and software promise an even greater role for the technique.

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A multi-institutional analysis of complication outcomes after arteriovenous malformation radiosurgery

Cited by 228 publications

References 15 publications

Evaluating Critical Brain Radiation Doses in the Treatment of Multiple Brain Lesions with Gamma Knife Radiosurgery

Evaluating Critical Brain Radiation Doses in the Treatment of Multiple Brain Lesions with Gamma Knife Radiosurgery

Arteriovenous malformations in the brain

Advances in stereotactic radiosurgery for brain neoplasms

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