Adverse radiation effects after Gamma Knife Surgery in relation to dose and volume

Ganz, Jeremy C.; Reda, Wael A; Abdelkarim, Khaled

doi:10.1007/s00701-008-0174-4

Cited by 60 publications

(31 citation statements)

References 85 publications

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“…Thus, the frequency with which said findings are reported varies from one study to the next. Foroughi et al 12 reported a 2.2%-9% incidence of necrotic masses after SRS, while Ganz et al 13 reported a 60% incidence for radiation-induced changes. Several factors, including radiation dose and target vol- ume, are reported as important predictors for radiological changes.…”

Section: 21mentioning

confidence: 99%

“…Several factors, including radiation dose and target vol- ume, are reported as important predictors for radiological changes. [12][13][14] Other risk factors for ARE, such as prior hemorrhage, 14 AVM location, 9 and repeated radiosurgery, 4 have been described in some series. In this study, we have assessed overall pretreatment multivariate predictors of favorable outcome in a large patient cohort undergoing GKRS.…”

Section: 21mentioning

confidence: 99%

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A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

Cohen-Inbar

Lee

et al. 2015

JNS

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OBJECT The authors review outcomes following Gamma Knife radiosurgery (GKRS) of cerebral arteriovenous malformations (AVMs) and their correlation to postradiosurgery adverse radiation effects (AREs). METHODS From a prospective institutional review board–approved database, the authors identified patients with a minimum of 2 years of follow-up and thin-slice T2-weighted MRI sequences for volumetric analysis. A total of 105 AVM patients were included. The authors analyzed the incidence and quantitative changes in AREs as a function of time after GKRS. Statistical analysis was performed to identify factors related to ARE development and changes in the ARE index. RESULTS The median clinical follow-up was 53.8 months (range 24–212.4 months), and the median MRI follow-up was 36.8 months (range 24–212.4 months). 47.6% of patients had an AVM with a Spetzler-Martin grade ≥ III. The median administered margin and maximum doses were 22 and 40 Gy, respectively. The overall obliteration rate was 70.5%. Of patients who showed complete obliteration, 74.4% developed AREs within 4–6 months after GKRS. Late-onset AREs (i.e., > 12 months) correlated to a failure to obliterate the nidus. 58.1% of patients who developed appreciable AREs (defined as ARE index > 8) proceeded to have a complete nidus obliteration. Appreciable AREs were found to be influenced by AVM nidus volume > 3 ml, lobar location, number of draining veins and feeding arteries, prior embolization, and higher margin dose. On the other hand, a minimum ARE index > 8 predicted obliteration (p = 0.043). CONCLUSIONS ARE development after radiosurgery follows a temporal pattern peaking at 7–12 months after stereotactic radiosurgery. The ARE index serves as an important adjunct tool in patient follow-up and outcome prediction.

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Section: 21mentioning

confidence: 99%

Section: 21mentioning

confidence: 99%

A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

Cohen-Inbar

Lee

et al. 2015

JNS

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“…Furthermore, it is worth stressing that -even treating larger volumes -either with reduced dosages or with fractionated schedules, the literature shows no evidence of significantly increased "Adverse Radiation Effects" ("ARE"). Probably because the risk of "ARE" gradually subsides with lower prescription doses (3,18,19,22,31,38,47,49,64,65,70).…”

Section: Gamma Knife Radiosurgerymentioning

confidence: 99%

“…dose volume integral, conformity index etc. (6,20,22,56,72,83,86) However, recent reports have emphasized the extremely high chances to maintain adequate LTC rates -without increasing side effects-by treating larger meningiomas with either fractionated schedules or reduced dosages (3,13,18,19,22,24,31,32). b. the controversial or disappointing results obtained in atypic and anaplastic lesions (17,25,27,30,51,73), sometimes characterized by intra-or extraneuraxis metastatization (17) or by enhanced growth after radiosurgery (6,14,42); c. the still pronounced morbidity rate of this technique on sensory nerves (6,14,77).…”

Section: Anaplastic (Gr 3) Meningiomamentioning

confidence: 99%

Radiosurgical Treatment of Intracranial Meningiomas: Update 2011

Gerosa¹,

Foroni²,

Longhi³

et al. 2011

Gamma Knife Radiosurgery

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“…In particular, the volume around the AVM's target exposed to 12 Gy or more carries an increased risk of radiological and clinical radiation damage [43,[70][71][72] . Our limited number of complications is probably related to small volumes treated and to the relatively low doses used.…”

Section: Radiation-induced Complicationsmentioning

confidence: 99%

Linac Stereotactic Radiosurgery for the Treatment of Small Arteriovenous Malformations: Lower Doses Can Be Equally Effective

Flores¹,

Sallabanda²,

Santos³

et al. 2011

Stereotact Funct Neurosurg

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Objective: The purpose of this study was to examine the efficacy and toxicity of treating small arteriovenous malformations (AVMs) (≤3 cm in diameter) with a median marginal applied dose of 14 Gy. Methods: Two hundred and thirteen patients diagnosed with AVMs were treated between January 1991 and December 2005. Seventy-three percent of the patients had hemorrhaged prior to treatment, 13% had had previous surgery and 19.2% had had previous embolization. The median follow-up duration was 48.1 months. Results: The Kaplan-Meier analysis estimated that the 36-month obliteration rate was 65.5% for patients undergoing their first stereotactic radiosurgery (SRS) and 68.3% for those undergoing repeated SRS. The Kaplan-Meier analysis estimated the 60-month AVMs obliteration rate for the entire cohort to be 82.4%. The median time to AVM obliteration was 40 ± 2.8 months. We found a statistically significant relationship between the time of obliteration and the following factors: site of the AVMs (sites other than brainstem), a higher prescribed dose and a positive history of previous hemorrhage. Thirteen patients (7.6%) experienced toxicities. Conclusions: SRS was an effective and safe treatment for AVMs ≤3 cm in diameter, with acceptable toxicity.

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Adverse radiation effects after Gamma Knife Surgery in relation to dose and volume

Cited by 60 publications

References 85 publications

A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations

Radiosurgical Treatment of Intracranial Meningiomas: Update 2011

Linac Stereotactic Radiosurgery for the Treatment of Small Arteriovenous Malformations: Lower Doses Can Be Equally Effective

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