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Title: Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations

Abstract

Purpose: To investigate predictive factors in the development of symptomatic radiation injury after treatment with linear accelerator-based stereotactic radiosurgery for intracerebral arteriovenous malformations and relate the findings to the conclusions drawn by Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC). Methods and Materials: Archived plans for 73 patients who were treated at the British Columbia Cancer Agency were studied. Actuarial estimates of freedom from radiation injury were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of radiation injury. Log-rank test was used to search for dosimetric parameters associated with freedom from radiation injury. Results: Symptomatic radiation injury was exhibited by 14 of 73 patients (19.2%). Actuarial rate of symptomatic radiation injury was 23.0% at 4 years. Most patients (78.5%) had mild to moderate deficits according to Common Terminology Criteria for Adverse Events, version 4.0. On univariate analysis, lesion volume and diameter, dose to isocenter, and a V{sub x} for doses {>=}8 Gy showed statistical significance. Only lesion diameter showed statistical significance (p < 0.05) in a multivariate model. According to the log-rank test, AVM volumes >5 cm{sup 3} and diameters >30 mm were significantly associated with the riskmore » of radiation injury (p < 0.01). The V{sub 12} also showed strong association with the incidence of radiation injury. Actuarial incidence of radiation injury was 16.8% if V{sub 12} was <28 cm{sup 3} and 53.2% if >28 cm{sup 3} (log-rank test, p = 0.001). Conclusions: This study confirms that the risk of developing symptomatic radiation injury after radiosurgery is related to lesion diameter and volume and irradiated volume. Results suggest a higher tolerance than proposed by QUANTEC. The widely differing findings reported in the literature, however, raise considerable uncertainties.« less

Authors:
 [1];  [2];  [1];  [3];  [4]; ; ; ;  [2];  [3];  [5];  [3];  [6]
  1. Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC (Canada)
  2. Department of Medical Physics, British Columbia Cancer Agency, Vancouver, BC (Canada)
  3. Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada)
  4. Department of Radiation Oncology, British Columbia Cancer Agency, Abbotsford, BC (Canada)
  5. Department of Neurosurgery, Royal Columbian Hospital, New Westminster, BC (Canada)
  6. Department of Medical Imaging, British Columbia Cancer Agency, Vancouver, BC (Canada)
Publication Date:
OSTI Identifier:
22058889
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 83; Journal Issue: 3; 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; HAZARDS; LINEAR ACCELERATORS; MALFORMATIONS; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIATION INJURIES; RADIOTHERAPY; SURGERY

Citation Formats

Herbert, Christopher, Moiseenko, Vitali, McKenzie, Michael, Redekop, Gary, Hsu, Fred, Gete, Ermias, Gill, Brad, Lee, Richard, Luchka, Kurt, Haw, Charles, Lee, Andrew, Toyota, Brian, and Martin, Montgomery. Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.08.019.
Herbert, Christopher, Moiseenko, Vitali, McKenzie, Michael, Redekop, Gary, Hsu, Fred, Gete, Ermias, Gill, Brad, Lee, Richard, Luchka, Kurt, Haw, Charles, Lee, Andrew, Toyota, Brian, & Martin, Montgomery. Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations. United States. https://doi.org/10.1016/J.IJROBP.2011.08.019
Herbert, Christopher, Moiseenko, Vitali, McKenzie, Michael, Redekop, Gary, Hsu, Fred, Gete, Ermias, Gill, Brad, Lee, Richard, Luchka, Kurt, Haw, Charles, Lee, Andrew, Toyota, Brian, and Martin, Montgomery. 2012. "Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations". United States. https://doi.org/10.1016/J.IJROBP.2011.08.019.
@article{osti_22058889,
title = {Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations},
author = {Herbert, Christopher and Moiseenko, Vitali and McKenzie, Michael and Redekop, Gary and Hsu, Fred and Gete, Ermias and Gill, Brad and Lee, Richard and Luchka, Kurt and Haw, Charles and Lee, Andrew and Toyota, Brian and Martin, Montgomery},
abstractNote = {Purpose: To investigate predictive factors in the development of symptomatic radiation injury after treatment with linear accelerator-based stereotactic radiosurgery for intracerebral arteriovenous malformations and relate the findings to the conclusions drawn by Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC). Methods and Materials: Archived plans for 73 patients who were treated at the British Columbia Cancer Agency were studied. Actuarial estimates of freedom from radiation injury were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of radiation injury. Log-rank test was used to search for dosimetric parameters associated with freedom from radiation injury. Results: Symptomatic radiation injury was exhibited by 14 of 73 patients (19.2%). Actuarial rate of symptomatic radiation injury was 23.0% at 4 years. Most patients (78.5%) had mild to moderate deficits according to Common Terminology Criteria for Adverse Events, version 4.0. On univariate analysis, lesion volume and diameter, dose to isocenter, and a V{sub x} for doses {>=}8 Gy showed statistical significance. Only lesion diameter showed statistical significance (p < 0.05) in a multivariate model. According to the log-rank test, AVM volumes >5 cm{sup 3} and diameters >30 mm were significantly associated with the risk of radiation injury (p < 0.01). The V{sub 12} also showed strong association with the incidence of radiation injury. Actuarial incidence of radiation injury was 16.8% if V{sub 12} was <28 cm{sup 3} and 53.2% if >28 cm{sup 3} (log-rank test, p = 0.001). Conclusions: This study confirms that the risk of developing symptomatic radiation injury after radiosurgery is related to lesion diameter and volume and irradiated volume. Results suggest a higher tolerance than proposed by QUANTEC. The widely differing findings reported in the literature, however, raise considerable uncertainties.},
doi = {10.1016/J.IJROBP.2011.08.019},
url = {https://www.osti.gov/biblio/22058889}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 83,
place = {United States},
year = {Sun Jul 01 00:00:00 EDT 2012},
month = {Sun Jul 01 00:00:00 EDT 2012}
}