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Title: Toxicity of Gamma Knife Radiosurgery in the Treatment of Intracranial Tumors in Patients With Collagen Vascular Diseases or Multiple Sclerosis

Abstract

Purpose: To assess toxicity in patients with either a collagen vascular disease (CVD) or multiple sclerosis (MS) treated with intracranial radiosurgery. Methods and Materials: Between January 2004 and April 2009, 6 patients with MS and 14 patients with a CVD were treated with Gamma Knife radiosurgery (GKRS) for intracranial tumors. Treated lesions included 15 total brain metastases in 7 patients, 11 benign brain tumors, 1 low grade glioma, and 1 cavernous malformation. Toxicities were graded by the Radiation Therapy Oncology Group Acute/Late Radiation Morbidity Scoring Criteria. 'Rare toxicities' were characterized as those reported in the scientific literature at an incidence of <5%. Results: Median follow-up time was 16 months. Median dose to the tumor margin was 13.0 Gy (range, 12-21 Gy). Median size of tumor was 5.0 cm{sup 3} (range, 0.14-7.8 cm{sup 3}). Of the 14 patients with CVD, none experienced a Grade 3 or 4 toxicity or a toxicity characterized as rare. Of the 6 patients with MS, 3 experienced rare toxicities, and two of these were Grade 3 toxicities. Rare complications included a patient experiencing both communicating hydrocephalus and facial nerve palsy, as well as 2 additional patients with motor cranial nerve palsy. High-grade toxicities included the patientmore » with an acoustic neuroma requiring ventriculoperitoneal shunt placement for obstructive hydrocephalus, and 1 patient with a facial nerve schwannoma who experienced permanent facial nerve palsy. Interval between radiosurgery and high-grade toxicities ranged from 1 week to 4 months. Conclusions: Our series suggests that patients with MS who receive GKRS may be at increased risk of rare and high-grade treatment-related toxicity. Given the time course of toxicity, treatment-related edema or demyelination represent potential mechanisms.« less

Authors:
 [1];  [2]; ; ;  [1];  [2];  [3]; ; ; ;  [1];  [1]
  1. Department of Radiation Oncology, School of Medicine, Wake Forest University, Winston-Salem, NC (United States)
  2. Department of Neurosurgery, School of Medicine, Wake Forest University, Winston-Salem, NC (United States)
  3. Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC (United States)
Publication Date:
OSTI Identifier:
22054421
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 81; Journal Issue: 4; Other Information: Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; BYPASSES; COLLAGEN; DISEASE INCIDENCE; EDEMA; GLIOMAS; GY RANGE 10-100; HAZARDS; MALFORMATIONS; METASTASES; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY; VASCULAR DISEASES

Citation Formats

Lowell, Dot, Tatter, Stephen B., Bourland, J. Daniel, Guzman, Allan F. de, Ekstrand, Kenneth E., Ellis, Thomas L., Lovato, James F., McMullen, Kevin P., Munley, Michael T., Shaw, Edward G., Urbanic, James J., and Chan, Michael D., E-mail: mchan@wfubmc.edu. Toxicity of Gamma Knife Radiosurgery in the Treatment of Intracranial Tumors in Patients With Collagen Vascular Diseases or Multiple Sclerosis. United States: N. p., 2011. Web. doi:10.1016/J.IJROBP.2011.02.056.
Lowell, Dot, Tatter, Stephen B., Bourland, J. Daniel, Guzman, Allan F. de, Ekstrand, Kenneth E., Ellis, Thomas L., Lovato, James F., McMullen, Kevin P., Munley, Michael T., Shaw, Edward G., Urbanic, James J., & Chan, Michael D., E-mail: mchan@wfubmc.edu. Toxicity of Gamma Knife Radiosurgery in the Treatment of Intracranial Tumors in Patients With Collagen Vascular Diseases or Multiple Sclerosis. United States. doi:10.1016/J.IJROBP.2011.02.056.
Lowell, Dot, Tatter, Stephen B., Bourland, J. Daniel, Guzman, Allan F. de, Ekstrand, Kenneth E., Ellis, Thomas L., Lovato, James F., McMullen, Kevin P., Munley, Michael T., Shaw, Edward G., Urbanic, James J., and Chan, Michael D., E-mail: mchan@wfubmc.edu. Tue . "Toxicity of Gamma Knife Radiosurgery in the Treatment of Intracranial Tumors in Patients With Collagen Vascular Diseases or Multiple Sclerosis". United States. doi:10.1016/J.IJROBP.2011.02.056.
@article{osti_22054421,
title = {Toxicity of Gamma Knife Radiosurgery in the Treatment of Intracranial Tumors in Patients With Collagen Vascular Diseases or Multiple Sclerosis},
author = {Lowell, Dot and Tatter, Stephen B. and Bourland, J. Daniel and Guzman, Allan F. de and Ekstrand, Kenneth E. and Ellis, Thomas L. and Lovato, James F. and McMullen, Kevin P. and Munley, Michael T. and Shaw, Edward G. and Urbanic, James J. and Chan, Michael D., E-mail: mchan@wfubmc.edu},
abstractNote = {Purpose: To assess toxicity in patients with either a collagen vascular disease (CVD) or multiple sclerosis (MS) treated with intracranial radiosurgery. Methods and Materials: Between January 2004 and April 2009, 6 patients with MS and 14 patients with a CVD were treated with Gamma Knife radiosurgery (GKRS) for intracranial tumors. Treated lesions included 15 total brain metastases in 7 patients, 11 benign brain tumors, 1 low grade glioma, and 1 cavernous malformation. Toxicities were graded by the Radiation Therapy Oncology Group Acute/Late Radiation Morbidity Scoring Criteria. 'Rare toxicities' were characterized as those reported in the scientific literature at an incidence of <5%. Results: Median follow-up time was 16 months. Median dose to the tumor margin was 13.0 Gy (range, 12-21 Gy). Median size of tumor was 5.0 cm{sup 3} (range, 0.14-7.8 cm{sup 3}). Of the 14 patients with CVD, none experienced a Grade 3 or 4 toxicity or a toxicity characterized as rare. Of the 6 patients with MS, 3 experienced rare toxicities, and two of these were Grade 3 toxicities. Rare complications included a patient experiencing both communicating hydrocephalus and facial nerve palsy, as well as 2 additional patients with motor cranial nerve palsy. High-grade toxicities included the patient with an acoustic neuroma requiring ventriculoperitoneal shunt placement for obstructive hydrocephalus, and 1 patient with a facial nerve schwannoma who experienced permanent facial nerve palsy. Interval between radiosurgery and high-grade toxicities ranged from 1 week to 4 months. Conclusions: Our series suggests that patients with MS who receive GKRS may be at increased risk of rare and high-grade treatment-related toxicity. Given the time course of toxicity, treatment-related edema or demyelination represent potential mechanisms.},
doi = {10.1016/J.IJROBP.2011.02.056},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 81,
place = {United States},
year = {2011},
month = {11}
}