Long term treatment efficacy & complications of hypofractionated stereotactic radiosurgery in brain arteriovenous malformations
| Autor: | Aurora K.Y. Tam, Kevin Lim, George K.C. Wong, Darren Poon, Michael Cheung, David Yuen Chung Chan, Michael Kam |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male medicine.medical_specialty Long term treatment Adolescent medicine.medical_treatment Neurological morbidity Radiosurgery Lesion Young Adult 03 medical and health sciences 0302 clinical medicine Physiology (medical) medicine Humans Child Radiation Injuries Vein Retrospective Studies business.industry Brain Arteriovenous malformation General Medicine Middle Aged medicine.disease Progression-Free Survival Treatment Outcome medicine.anatomical_structure Neurology Child Preschool 030220 oncology & carcinogenesis Female Surgery Neurology (clinical) Radiology medicine.symptom Complication business Reporting system 030217 neurology & neurosurgery |
| Zdroj: | Journal of Clinical Neuroscience. 82:241-246 |
| ISSN: | 0967-5868 |
| DOI: | 10.1016/j.jocn.2020.10.057 |
| Popis: | Objective To evaluate long term treatment efficacy and complications of hypofractionated stereotactic radiosurgery (hfSRS) and identify factors that predict outcomes. Methods A retrospective review was conducted on 34 consecutive patients who received hfSRS from 2008 to 2017. Demographic, clinical, angio-architectural characteristics, and radiosurgery data were extracted from the Clinical Data Analysis and Reporting System and our unit’s iPlan (BrainLAB, Munich) system. Data was analysed using SPSS. Results 5-year obliteration rate was 39.1%. Most patients (n = 29, 85.3%) recovered well with GOS of 4–5. 26.9% (n = 9) patients have at least one post-radiosurgery complication including hemorrhage, neurological deficits, radionecrosis. Neurological morbidity and mortality was 17.6% (n = 6). A higher modified radiosurgery arteriovenous malformation score (mRBAS) is associated with a lower 5-year obliteration rate (Rho = -0.486, p = 0.025). None of the bAVM were obliterated once mRBAS exceeds 5.35. As expected, a larger 20-Gy volume outside lesion is associated with more complications and poorer GOS. Interestingly, irradiated drainage vein volume indexed to AVM volume (iiDVV) correlates with increased risks of post-hfSRS haemorrhage (Rho = 0.472, p = 0.031) and reduced event-free survival (Rho = −0.472, p = 0.031). Once iiDVV exceeds 20%, a high rebleeding rate after hfSRS is anticipated (AUC under ROC 0.889). Conclusion Hypofractionated stereotactic radiosurgery is an alternative radiosurgery treatment for bAVM unsuitable for single-fraction SRS. mRBAS predicts obliteration rate and morbidity in hfSRS. Index irradiated drainage vein volume (iiDVV) is associated with event-free survival and rebleeding and should be minimized if feasible. |
| Databáze: | OpenAIRE |
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