skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Proposal for a New Prognostic Score for Linac-Based Radiosurgery in Cerebral Arteriovenous Malformations

Abstract

Purpose: We evaluate patient-, angioma-, and treatment-specific factors for successful obliteration of cerebral arteriovenous malformations (AVM) to develop a new appropriate score to predict patient outcome after linac-based radiosurgery (RS). Methods and Materials: This analysis in based on 293 patients with cerebral AVM. Mean age at treatment was 38.8 years (4-73 years). AVM classification according Spetzler-Martin was 55 patients Grade I (20.5%), 114 Grade II (42.5%), 79 Grade III (29.5%), 19 Grade IV (7.1%), and 1 Grade V (0.4%). Median maximum AVM diameter was 3.0 cm (range, 0.3-10 cm). Median dose prescribed to the 80% isodose was 18 Gy (range, 12-22 Gy). Eighty-five patients (29.1%) had prior partial embolization; 141 patients (51.9%) experienced intracranial hemorrhage before RS. Median follow-up was 4.2 years. Results: Age at treatment, maximum diameter, nidus volume, and applied dose were significant factors for successful obliteration. Under presumption of proportional hazard in the dose range between 12 and 22 Gy/80% isodose, an increase of obliteration rate of approximately 25% per Gy was seen. On the basis of multivariate analysis, a prediction score was calculated including AVM maximum diameter and age at treatment. The prediction error up to the time point 8 years was 0.173 for the Heidelbergmore » score compared with the Kaplan-Meier value of 0.192. An increase of the score of 1 point results in a decrease of obliteration chance by a factor of 0.447. Conclusion: The proposed score is linac-based radiosurgery-specific and easy to handle to predict patient outcome. Further validation on an independent patient cohort is necessary.« less

Authors:
 [1];  [2];  [1];  [3];  [4];  [1];  [1];  [5]
  1. Department of Radio-oncology and Radiotherapy, University of Heidelberg, Heidelberg (Germany)
  2. Department of Biostatistics, German Cancer Research Center, Heidelberg (Germany)
  3. Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany)
  4. Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany)
  5. (Germany)
Publication Date:
OSTI Identifier:
22056381
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 83; Journal Issue: 2; Other Information: Copyright (c) 2012 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; ANGIOMAS; CLASSIFICATION; FORECASTING; GY RANGE 10-100; HAZARDS; HEMORRHAGE; LINEAR ACCELERATORS; MALFORMATIONS; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY

Citation Formats

Milker-Zabel, Stefanie, E-mail: Stefanie_Milker-Zabel@med.uni-heidelberg.de, Kopp-Schneider, Annette, Wiesbauer, Hannah, Schlegel, Wolfgang, Huber, Peter, Debus, Juergen, Zabel-du Bois, Angelika, and Department of Radiotherapy, German Cancer Research Center, Heidelberg. Proposal for a New Prognostic Score for Linac-Based Radiosurgery in Cerebral Arteriovenous Malformations. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.07.008.
Milker-Zabel, Stefanie, E-mail: Stefanie_Milker-Zabel@med.uni-heidelberg.de, Kopp-Schneider, Annette, Wiesbauer, Hannah, Schlegel, Wolfgang, Huber, Peter, Debus, Juergen, Zabel-du Bois, Angelika, & Department of Radiotherapy, German Cancer Research Center, Heidelberg. Proposal for a New Prognostic Score for Linac-Based Radiosurgery in Cerebral Arteriovenous Malformations. United States. doi:10.1016/J.IJROBP.2011.07.008.
Milker-Zabel, Stefanie, E-mail: Stefanie_Milker-Zabel@med.uni-heidelberg.de, Kopp-Schneider, Annette, Wiesbauer, Hannah, Schlegel, Wolfgang, Huber, Peter, Debus, Juergen, Zabel-du Bois, Angelika, and Department of Radiotherapy, German Cancer Research Center, Heidelberg. Fri . "Proposal for a New Prognostic Score for Linac-Based Radiosurgery in Cerebral Arteriovenous Malformations". United States. doi:10.1016/J.IJROBP.2011.07.008.
@article{osti_22056381,
title = {Proposal for a New Prognostic Score for Linac-Based Radiosurgery in Cerebral Arteriovenous Malformations},
author = {Milker-Zabel, Stefanie, E-mail: Stefanie_Milker-Zabel@med.uni-heidelberg.de and Kopp-Schneider, Annette and Wiesbauer, Hannah and Schlegel, Wolfgang and Huber, Peter and Debus, Juergen and Zabel-du Bois, Angelika and Department of Radiotherapy, German Cancer Research Center, Heidelberg},
abstractNote = {Purpose: We evaluate patient-, angioma-, and treatment-specific factors for successful obliteration of cerebral arteriovenous malformations (AVM) to develop a new appropriate score to predict patient outcome after linac-based radiosurgery (RS). Methods and Materials: This analysis in based on 293 patients with cerebral AVM. Mean age at treatment was 38.8 years (4-73 years). AVM classification according Spetzler-Martin was 55 patients Grade I (20.5%), 114 Grade II (42.5%), 79 Grade III (29.5%), 19 Grade IV (7.1%), and 1 Grade V (0.4%). Median maximum AVM diameter was 3.0 cm (range, 0.3-10 cm). Median dose prescribed to the 80% isodose was 18 Gy (range, 12-22 Gy). Eighty-five patients (29.1%) had prior partial embolization; 141 patients (51.9%) experienced intracranial hemorrhage before RS. Median follow-up was 4.2 years. Results: Age at treatment, maximum diameter, nidus volume, and applied dose were significant factors for successful obliteration. Under presumption of proportional hazard in the dose range between 12 and 22 Gy/80% isodose, an increase of obliteration rate of approximately 25% per Gy was seen. On the basis of multivariate analysis, a prediction score was calculated including AVM maximum diameter and age at treatment. The prediction error up to the time point 8 years was 0.173 for the Heidelberg score compared with the Kaplan-Meier value of 0.192. An increase of the score of 1 point results in a decrease of obliteration chance by a factor of 0.447. Conclusion: The proposed score is linac-based radiosurgery-specific and easy to handle to predict patient outcome. Further validation on an independent patient cohort is necessary.},
doi = {10.1016/J.IJROBP.2011.07.008},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 83,
place = {United States},
year = {2012},
month = {6}
}