Clinical outcomes following stereotactic radiosurgery for cerebral cavernous malformations of the basal ganglia and thalamus-Reference-Cited by-同舟云学术

Clinical outcomes following stereotactic radiosurgery for cerebral cavernous malformations of the basal ganglia and thalamus

Published:2023-12-01 Issue: Volume: Page:1-7
ISSN:0022-3085
Container-title:Journal of Neurosurgery
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Author:

Singh Raj¹,Dumot Chloe²³,Mantziaris Georgios²,Dayawansa Sam²,Xu Zhiyuan²,Pikis Stylianos²,Peker Selcuk⁴,Samanci Yavuz⁴,Ardor Gokce D.⁴,Nabeel Ahmed M.⁵⁶,Reda Wael A.⁵⁷,Tawadros Sameh R.⁵⁷,Abdel Karim Khaled⁵⁸,El-Shehaby Amr M. N.⁵⁷,Emad Eldin Reem M.⁵⁹,Sheehan Darrah²,Sheehan Kimball²,Elazzazi Ahmed H.¹⁰,Martínez Moreno Nuria¹¹,Martínez Álvarez Roberto¹¹,Liscak Roman¹²,May Jaromir¹²,Mathieu David¹³,Tourigny Jean-Nicolas¹³,Tripathi Manjul⁷,Rajput Akshay⁷,Kumar Narendra¹⁴,Kaur Rupinder⁷,Picozzi Piero¹⁵,Franzini Andrea¹⁵,Speckter Herwin¹⁶,Hernandez Wenceslao¹⁶,Brito Anderson¹⁶,Warnick Ronald E.¹⁷,Alzate Juan Diego¹⁸,Kondziolka Douglas¹⁸,Bowden Greg N.¹⁹,Patel Samir²⁰,Sheehan Jason P.²

Affiliation:

1. Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio;

2. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia;

3. Department of Neurological Surgery, Civil Hospices of Lyon, France;

4. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey;

5. Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt;

6. Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya, Egypt;

7. Departments of Neurosurgery and

8. Clinical Oncology, Ain Shams University, Cairo, Egypt;

9. Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt;

10. Extended Modular Program, Faculty of Medicine, Ain Shams University, Cairo, Egypt;

11. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain;

12. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;

13. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada;

14. Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

15. Department of Neurosurgery, Scientific Institute for Research, Hospitalization and Healthcare–IRCCS Humanitas Research Hospital, Milan, Italy;

16. Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic;

17. Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio;

18. Department of Neurosurgery, NYU Langone, New York, New York;

19. Department of Neurosurgery and

20. Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada

Abstract

OBJECTIVE There are few reports of outcomes following stereotactic radiosurgery (SRS) for the management of cerebral cavernous malformations (CCMs) of the basal ganglia or thalamus. Therefore, the authors aimed to clarify these outcomes. METHODS Centers participating in the International Radiosurgery Research Foundation were queried for CCM cases managed with SRS from October 2001 to February 2021. The primary outcome of interest was hemorrhage-free survival (HFS) with a secondary outcome of symptomatic adverse radiation events (AREs). Assessment of the association of prognostic factors with HFS was conducted via Kaplan-Meier analysis and log-rank test. Chi-square tests were conducted to assess potential factors associated with the incidence of AREs. RESULTS Seventy-three patients were identified. The median patient age was 43.5 years (range 4.4–79.5 years). Fifty-nine (80.8%) patients had hemorrhage prior to SRS. The median treatment volume was 0.9 cm3 (range 0.07–10.1 cm3) with a median margin prescription dose (MPD) of 12 Gy (range 10–20 Gy). One-, 3-, 5-, and 10-year HFS were 93.0%, 89.9%, 89.9%, and 83.0%, respectively, with one hemorrhage-related death approximately 1 year after SRS and nearly 60% and 30% of patients having improvement or stability of symptoms, respectively. There was no correlation between lesion size or MPD and HFS. Seven (9.6%) patients experienced AREs (MPDs > 12 Gy in all cases). Lesion size > 1.0 cm3 was correlated with the incidence of an ARE (p = 0.019). Forty-two (93.3%) of 45 patients treated with an MPD ≤ 12 Gy experienced neither hemorrhage nor AREs following SRS versus 17 (60.7%) of 28 patients treated with an MPD > 12 Gy (p = 0.0006). CONCLUSIONS SRS is a reasonable treatment strategy and confers clinical stability or improvement and hemorrhage avoidance in patients harboring CCMs of the basal ganglia or thalamus. An MPD of approximately 12 Gy is recommended for the management of CCM.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

Link

https://thejns.org/downloadpdf/journals/j-neurosurg/aop/article-10.3171-2023.10.JNS231894/article-10.3171-2023.10.JNS231894.xml

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