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Beneš V, Bubeníková A, Skalický P, Bradáč O. Treatment of Brain Arteriovenous Malformations. Adv Tech Stand Neurosurg 2024; 49:139-179. [PMID: 38700684 DOI: 10.1007/978-3-031-42398-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Brain arteriovenous malformations (AVMs) are a rare entity of vascular anomalies, characteristic of anatomical shunting where arterial blood directly flows into the venous circulation. The main aim of the active treatment policy of brain AVMs is the prevention of haemorrhage. There are well-established treatment strategies that continually improve in their safety and efficacy, primarily due to the advances in imaging modalities, targeted and novel techniques, the development of alternative treatment approaches, and even better experience with the disease itself. There are interesting imaging novelties that may be prospectively applicable in the decision-making and planning of the most effective treatment approach for individual patients with intracranial AVM. Surgery is often considered the first-line treatment; however, each patient should be evaluated individually, and the risks of the active treatment policy should not overcome the benefits of the spontaneous natural history of the disease. All treatment modalities, i.e., surgery, radiosurgery, endovascular embolization, and observation, are justified but need to be meticulously selected for each individual patient in order to deliver the best treatment outcome. This chapter deals with historical and currently applied dogmas, followed by introductions of advances in each available treatment modality of AVM management.
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Affiliation(s)
- Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Skalický
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery and Neurooncology, Military University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Neurosurgery, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Loo M, Clavier JB, Attal Khalifa J, Moyal E, Khalifa J. Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review. Cancers (Basel) 2021; 13:cancers13236086. [PMID: 34885193 PMCID: PMC8657210 DOI: 10.3390/cancers13236086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Brain metastases are one of the most frequent complications for cancer patients. Stereotactic radiosurgery is considered a cornerstone treatment for patients with limited brain metastases and the ideal dose and fractionation schedule still remain unknown. The aim of this literature review is to discuss the dose-effect relation in brain metastases treated by stereotactic radiosurgery, accounting for fractionation and technical considerations. Abstract For more than two decades, stereotactic radiosurgery has been considered a cornerstone treatment for patients with limited brain metastases. Historically, radiosurgery in a single fraction has been the standard of care but recent technical advances have also enabled the delivery of hypofractionated stereotactic radiotherapy for dedicated situations. Only few studies have investigated the efficacy and toxicity profile of different hypofractionated schedules but, to date, the ideal dose and fractionation schedule still remains unknown. Moreover, the linear-quadratic model is being debated regarding high dose per fraction. Recent studies shown the radiation schedule is a critical factor in the immunomodulatory responses. The aim of this literature review was to discuss the dose–effect relation in brain metastases treated by stereotactic radiosurgery accounting for fractionation and technical considerations. Efficacy and toxicity data were analyzed in the light of recent published data. Only retrospective and heterogeneous data were available. We attempted to present the relevant data with caution. A BED10 of 40 to 50 Gy seems associated with a 12-month local control rate >70%. A BED10 of 50 to 60 Gy seems to achieve a 12-month local control rate at least of 80% at 12 months. In the brain metastases radiosurgery series, for single-fraction schedule, a V12 Gy < 5 to 10 cc was associated to 7.1–22.5% radionecrosis rate. For three-fractions schedule, V18 Gy < 26–30 cc, V21 Gy < 21 cc and V23 Gy < 5–7 cc were associated with about 0–14% radionecrosis rate. For five-fractions schedule, V30 Gy < 10–30 cc, V 28.8 Gy < 3–7 cc and V25 Gy < 16 cc were associated with about 2–14% symptomatic radionecrosis rate. There are still no prospective trials comparing radiosurgery to fractionated stereotactic irradiation.
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Affiliation(s)
- Maxime Loo
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
- Correspondence:
| | - Jean-Baptiste Clavier
- Radiotherapy Department, Strasbourg Europe Cancer Institute (ICANS), 67033 Strasbourg, France;
| | - Justine Attal Khalifa
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
| | - Elisabeth Moyal
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
| | - Jonathan Khalifa
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
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3
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Milano MT, Grimm J, Niemierko A, Soltys SG, Moiseenko V, Redmond KJ, Yorke E, Sahgal A, Xue J, Mahadevan A, Muacevic A, Marks LB, Kleinberg LR. Single- and Multifraction Stereotactic Radiosurgery Dose/Volume Tolerances of the Brain. Int J Radiat Oncol Biol Phys 2020; 110:68-86. [PMID: 32921513 DOI: 10.1016/j.ijrobp.2020.08.013] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy investigating normal tissue complication probability (NTCP) after hypofractionated radiation therapy, data from published reports (PubMed indexed 1995-2018) were pooled to identify dosimetric and clinical predictors of radiation-induced brain toxicity after single-fraction stereotactic radiosurgery (SRS) or fractionated stereotactic radiosurgery (fSRS). METHODS AND MATERIALS Eligible studies provided NTCPs for the endpoints of radionecrosis, edema, or symptoms after cranial SRS/fSRS and quantitative dose-volume metrics. Studies of patients with only glioma, meningioma, vestibular schwannoma, or brainstem targets were excluded. The data summary and analyses focused on arteriovenous malformations (AVM) and brain metastases. RESULTS Data from 51 reports are summarized. There was wide variability in reported rates of radionecrosis. Available data for SRS/fSRS for brain metastases were more amenable to NTCP modeling than AVM data. In the setting of brain metastases, SRS/fSRS-associated radionecrosis can be difficult to differentiate from tumor progression. For single-fraction SRS to brain metastases, tissue volumes (including target volumes) receiving 12 Gy (V12) of 5 cm3, 10 cm3, or >15 cm3 were associated with risks of symptomatic radionecrosis of approximately 10%, 15%, and 20%, respectively. SRS for AVM was associated with modestly lower rates of symptomatic radionecrosis for equivalent V12. For brain metastases, brain plus target volume V20 (3-fractions) or V24 (5-fractions) <20 cm3 was associated with <10% risk of any necrosis or edema, and <4% risk of radionecrosis requiring resection. CONCLUSIONS The risk of radionecrosis after SRS and fSRS can be modeled as a function of dose and volume treated. The use of fSRS appears to reduce risks of radionecrosis for larger treatment volumes relative to SRS. More standardized dosimetric and toxicity reporting is needed to facilitate future pooled analyses that can refine predictive models of brain toxicity risks.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York.
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jinyu Xue
- Department of Radiation Oncology, NYU Langone Medical Center, New York City, NY
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania
| | | | - Lawrence B Marks
- Department of Radiation Oncology and Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Jacob J, Reyns N, Valéry CA, Feuvret L, Simon JM, Mazeron JJ, Jenny C, Cuttat M, Maingon P, Pasquier D. Radiotherapy of non-tumoral refractory neurological pathologies. Cancer Radiother 2020; 24:523-533. [PMID: 32859467 DOI: 10.1016/j.canrad.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
Intracranial radiotherapy has been improved, primarily because of the development of stereotactic approaches. While intracranial stereotactic body radiotherapy is mainly indicated for treatment of benign or malignant tumors, this procedure is also effective in the management of other neurological pathologies; it is delivered using GammaKnife® and linear accelerators. Thus, brain arteriovenous malformations in patients who are likely to experience permanent neurological sequelae can be managed by single session intracranial stereotactic body radiotherapy, or radiosurgery, in specific situations, with an advantageous benefit/risk ratio. Radiosurgery can be recommended for patients with disabling symptoms, which are poorly controlled by medication, such as trigeminal neuralgia, and tremors, whether they are essential or secondary to Parkinson's disease. This literature review aims at defining the place of intracranial stereotactic body radiotherapy in the management of patients suffering from non-tumoral refractory neurological pathologies. It is clear that the multidisciplinary collaboration of experienced teams from Neurosurgery, Neurology, Neuroradiology, Radiation Oncology and Medical Physics is needed for the procedures using high precision radiotherapy techniques, which deliver high doses to locations near functional brain areas.
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Affiliation(s)
- J Jacob
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - N Reyns
- Centre Hospitalier Régional Universitaire de Lille, Department of Neurosurgery and Neuro-Oncology, Neurosurgery service, 2, avenue Oscar-Lambret, 59000 Lille, France; Lille University, Inserm, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, 1, avenue Oscar-Lambret, 59000 Lille, France
| | - C-A Valéry
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Neurosurgery, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-M Simon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Jenny
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Medical Physics, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Cuttat
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Medical Physics, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Maingon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Pasquier
- Centre Oscar-Lambret, Academic Department of Radiation Oncology, 3, rue Frédéric-Combemale, 59000 Lille, France; Lille University, Centre de Recherche en Informatique, Signal et Automatique de Lille, CRIStAL UMR 9189, Scientific Campus, bâtiment Esprit, avenue Henri-Poincaré, 59655 Villeneuve-d'Ascq, France
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5
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Wiggermann V, Lapointe E, Litvin L, Graf C, Hernández-Torres E, McKenzie M, Vavasour IM, Laule C, MacMillan EL, Li DKB, Kolind SH, Rauscher A, Traboulsee AL. Longitudinal advanced MRI case report of white matter radiation necrosis. Ann Clin Transl Neurol 2018; 6:379-385. [PMID: 30847370 PMCID: PMC6389755 DOI: 10.1002/acn3.704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 11/11/2022] Open
Abstract
Radiation necrosis mostly occurs in and near the radiation field. We used magnetic resonance imaging to study radiation-induced necrosis of atypical onset, severity, and extent following stereotactic radiosurgery for a symptomatic arteriovenous malformation. Susceptibility-sensitive imaging, T1-relaxation, myelin water imaging, and magnetic resonance spectroscopy were acquired three times up to 52 months postradiosurgery. Increasing water content outside the radiation field, contralateral neuronal loss, and gliosis were detected over time. Our findings suggest that radiation-induced vasculopathic changes spread more diffusely than previously described. An autoimmune response to brain antigens could underlie white matter changes outside the initial radiation field.
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Affiliation(s)
- Vanessa Wiggermann
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Pediatrics University of British Columbia Vancouver British Columbia Canada.,UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada
| | - Emmanuelle Lapointe
- Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada
| | - Ludmila Litvin
- Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Carina Graf
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,International Collaboration on Repair Discoveries (ICORD) University of British Columbia Vancouver British Columbia Canada
| | - Enedino Hernández-Torres
- Department of Pediatrics University of British Columbia Vancouver British Columbia Canada.,UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada
| | - Michael McKenzie
- Department of Surgery Division of Radiation Oncology and Developmental Radiotherapeutics University of British Columbia Vancouver British Columbia Canada
| | - Irene M Vavasour
- UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Cornelia Laule
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada.,International Collaboration on Repair Discoveries (ICORD) University of British Columbia Vancouver British Columbia Canada.,Department of Pathology & Laboratory Medicine University of British Columbia Vancouver British Columbia Canada
| | - Erin L MacMillan
- UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada.,Philips Markham Ontario Canada
| | - David K B Li
- Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Shannon H Kolind
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Alexander Rauscher
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Pediatrics University of British Columbia Vancouver British Columbia Canada.,UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Anthony L Traboulsee
- Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada
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Feutren T, Huertas A, Salleron J, Anxionnat R, Bracard S, Klein O, Peiffert D, Bernier-Chastagner V. Modern robot-assisted radiosurgery of cerebral angiomas-own experiences, system comparisons, and comprehensive literature overview. Neurosurg Rev 2017; 41:787-797. [PMID: 29105011 DOI: 10.1007/s10143-017-0926-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/07/2017] [Accepted: 10/23/2017] [Indexed: 02/05/2023]
Abstract
Cerebral arteriovenous malformations (AVMs) are rare vascular lesions potentially responsible for substantial neurological morbidity and mortality. Over the past four decades, radiosurgery has become a valid therapeutic option for many patients with small intracranial AVMs, but reports describing the use of robotic stereotactic radiosurgery (SRS) are rare. The purposes of this study are to describe the efficacy and toxicity of robotic SRS for AVMs and to review the literature. The reports of 48 consecutive patients treated with SRS were reviewed. A total dose of 18 Gy in a single fraction was prescribed to the 70% isodose line. Efficacy (i.e., total obliteration of the AVM) and toxicity were analyzed. Literature search was performed on Embase and PubMed for the terms "Radiosurgery and AVMs", "Cyberknife and AVMs" and "Radiation therapy and AVMs." The median follow-up was 41 months. The median AVM volume was 2.62 cm3. The incidence of obliteration was 59% at 3 years. Regarding toxicity, 92% of patients remained symptom-free, 66% developed radiogenic edema on MRI, and none developed radionecrosis. Forty-one patients (85%) had embolization prior to SRS. Our study was incorporated in an exhaustive review of 25 trials categorized by SRS technique. In this review, the median follow-up was 60 months. The median nidus volume was 2 cm3. The median overall obliteration rate for SRS was 68% (range 36 to 92). The median embolization rate prior to SRS was 31% (range 8.23 to 90). Compared to other studies, tolerability was excellent and the obliteration rate was acceptable but probably affected by the high embolization rate prior to radiosurgery. Our study suggests that a higher dose is feasible. A larger cohort with a longer follow-up period will be needed to confirm the safety and effectiveness, and subsequently validate different prognosis and predictive scores with this treatment modality to maximize the benefits of this technology for selected patients in the long term.
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Affiliation(s)
- Thomas Feutren
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France.
| | - Andres Huertas
- Department of Radiotherapy, Hôpital Européen Georges Pompidou, Paris, France
| | - Julia Salleron
- Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - René Anxionnat
- Department of Neuroradiology, Hôpital Central CHU de Nancy, Nancy, France
| | - Serge Bracard
- Department of Neuroradiology, Hôpital Central CHU de Nancy, Nancy, France
| | - Olivier Klein
- Department of Neurosurgery, Hôpital Central CHU de Nancy, Nancy, France
| | - Didier Peiffert
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Valérie Bernier-Chastagner
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
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Ilyas A, Chen CJ, Ding D, Buell TJ, Raper DMS, Lee CC, Xu Z, Sheehan JP. Radiation-Induced Changes After Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Systematic Review and Meta-Analysis. Neurosurgery 2017; 83:365-376. [DOI: 10.1093/neuros/nyx502] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
- Department of Neurosurgery, Barrow Neurologic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Daniel M S Raper
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- Department of Neurological Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Hatiboglu MA, Akdur K. Evaluating Critical Brain Radiation Doses in the Treatment of Multiple Brain Lesions with Gamma Knife Radiosurgery. Stereotact Funct Neurosurg 2017; 95:268-278. [DOI: 10.1159/000478272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022]
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9
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Linear Accelerator-Based Radiosurgery Alone for Arteriovenous Malformation: More Than 12 Years of Observation. Int J Radiat Oncol Biol Phys 2014; 89:576-83. [DOI: 10.1016/j.ijrobp.2014.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/31/2014] [Accepted: 03/11/2014] [Indexed: 11/20/2022]
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10
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Vascular endothelial growth factor blockade: A potential new therapy in the management of cerebral arteriovenous malformations. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2014. [DOI: 10.1016/j.jmhi.2013.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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11
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Hattangadi-Gluth JA, Chapman PH, Kim D, Niemierko A, Bussière MR, Stringham A, Daartz J, Ogilvy C, Loeffler JS, Shih HA. Single-Fraction Proton Beam Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations. Int J Radiat Oncol Biol Phys 2014; 89:338-46. [DOI: 10.1016/j.ijrobp.2014.02.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/13/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
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12
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Narayanasamy G, Smith A, Van Meter E, McGarry R, Molloy JA. Total target volume is a better predictor of whole brain dose from gamma stereotactic radiosurgery than the number, shape, or location of the lesions. Med Phys 2014; 40:091714. [PMID: 24007147 DOI: 10.1118/1.4818825] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess the hypothesis that the volume of whole brain that receives a certain dose level is primarily dependent on the treated volume rather than on the number, shape, or location of the lesions. This would help a physician validate the suitability of GammaKnife(®) based stereotactic radiosurgery (GKSR) prior to treatment. METHODS Simulation studies were performed to establish the hypothesis for both oblong and spherical shaped lesions of various numbers and sizes. Forty patients who underwent GKSR [mean age of 54 years (range 7-80), mean number of lesions of 2.5 (range 1-6), and mean lesion volume of 4.4 cm(3) (range 0.02-22.2 cm(3))] were also studied retrospectively. Following recommendations of QUANTEC, the volume of brain irradiated by the 12 Gy (VB12) isodose line was measured and a power-law based relation is proposed here for estimating VB12 from the known tumor volume and the prescription dose. RESULTS In the simulation study on oblong, spherical, and multiple lesions, the volume of brain irradiated by 50%, 10%, and 1% of maximum dose was found to have linear, linear, and exponentially increasing dependence on the volume of the treated region, respectively. In the retrospective study on 40 GKSR patients, a similar relationship was found to predict the brain dose with a Spearman correlation coefficient >0.9. In both the studies, the volume of brain irradiated by a certain dose level does not have a statistically significant relationship (p ≥ 0.05) with the number, shape, or position of the lesions. The measured VB12 agrees with calculation to within 1.7%. CONCLUSIONS The results from the simulation and the retrospective clinical studies indicate that the volume of whole brain that receives a certain percentage of the maximum dose is primarily dependent on the treated volume and less on the number, shape, and location of the lesions.
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Affiliation(s)
- Ganesh Narayanasamy
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536, USA
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13
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Sonier M, Gete E, Herbert C, McKenzie M, Murphy J, Moiseenko V. Intensity-modulated stereotactic radiosurgery for arteriovenous malformations: guidance for treatment planning. Radiat Oncol 2014; 9:73. [PMID: 24612667 PMCID: PMC3995862 DOI: 10.1186/1748-717x-9-73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 02/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background Stereotactic Radiosurgery (SRS) is a common tool used to treat Arteriovenous Malformations (AVMs) in anatomical locations associated with a risk of surgical complications. Despite high rates of clinical effectiveness, SRS carries a risk of toxicity as a result of radiation injury to brain tissue. The use of intensity-modulated radiotherapy (IMRT) has increased because it may lead to improved PTV conformity and better Normal Tissue (NT) sparing compared to 3D Conformal Radiotherapy (3DCRT). The aim of this study was twofold: 1) to develop simple patient stratification rules for the recommendation of IMRT planning strategies over 3DCRT in the treatment of AVMs with SRS; and 2) to estimate the impact of IMRT in terms of toxicity reduction using retrospectively reported data for symptomatic radiation injury following SRS. Methods Thirty-one AVM patients previously treated with 3DCRT were replanned in a commercial treatment planning system using 3DCRT and static gantry IMRT with identical beam arrangements. The radiotherapy planning metrics analyzed included AVM volume, diameter, and volume to surface area ratio. The dosimetric endpoints analyzed included conformity index improvements and NT sparing measured by the maximum NT dose, and the volume of surrounding tissue that received 7Gy and 12Gy. Results Our analysis revealed stratified subsets of patients for IMRT that were associated with improved conformity, and those that were associated with decreased doses to normal tissue. The stratified patients experienced an improvement in conformity index by −6-68%, a reduction in the maximum NT dose by −0.5-12.3%, a reduction in the volume of NT receiving 7Gy by 1-8 cc, and a reduction in the volume of NT receiving 12Gy by 0–3.7 cc. The reduction in NT receiving 12Gy translated to a theoretical decrease in the probability of symptomatic injury by 0–9.3%. Conclusions This work indicates the potential for significant patient improvements when treating AVMs and provides rules to predict which patients are likely to benefit from IMRT.
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Affiliation(s)
- Marcus Sonier
- British Columbia Cancer Agency, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
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Wahl M, Hwang A, Nakamura J, Barani I, Fogh S, Sneed P, McDermott M, Sahgal A, Ma L. Individual Beam Sharpening Improves Composite Dose Fall-off near a Target for Non-Isocentric Cyberknife Radiosurgery. Technol Cancer Res Treat 2013; 12:341-8. [DOI: 10.7785/tcrt.2012.500322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Stereotactic radiosurgery (SRS) refers to a high dose of radiation delivered to a focal region of interest while maximizing the steep dose gradient to minimize dose to the surrounding normal tissues. Multiple factors can influence the dose fall-off, and the relative importance of such factors have not yet been characterized for non-isocentric Cyberknife SRS. Our aim was to investigate whether the composite dose fall-off near a target may be enhanced via sharpening the lateral beam profile (or penumbra) of each individual beam. Cyberknife beam profiles were fitted and parameterized to obtain a characteristic penumbra function for each collimator size. Simulated beam profiles with progressively sharper penumbras were then generated, and used to perform simulated treatment planning on seven pediatric intracranial arteriovenous malformations (AVMs) cases. Penumbra size was found to significantly influence the peripheral dose fall-off. Peripheral dose volumes were reduced by 5 to 10% with reductions in penumbra size ranging from 40 to 80%. Dose conformality and homogeneity were not significantly changed with decreasing penumbra size. Therefore, individual beam sharpening provides a straightforward way of improving the composite dose fall-off for non-isocentric Cyberknife SRS.
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Affiliation(s)
- Michael Wahl
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
| | - Andrew Hwang
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
| | - Jean Nakamura
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
| | - Igor Barani
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
| | - Shannon Fogh
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
| | - Penny Sneed
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
| | - Michael McDermott
- Department of Neurosurgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and the Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, M6G 2M5, Canada
| | - Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco 505 Parnassus Ave, San Francisco, CA, 94143-0226
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Parkhutik V, Lago A, Aparici F, Vazquez JF, Tembl JI, Guillen L, Mainar E, Vazquez V. Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain. Neuroradiology 2012. [DOI: 10.1007/s00234-012-1115-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Radiochirurgie stéréotaxique des malformations artérioveineuses cérébrales. Cancer Radiother 2012; 16 Suppl:S46-56. [DOI: 10.1016/j.canrad.2012.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 05/28/2012] [Indexed: 11/19/2022]
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