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

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• 作者：Christopher Herbert ; F.R.C.R.^&lowast ; ; ^{cherbert@bccancer.bc.ca} ; Vitali Moiseenko ; Ph.D.^&dagger ; ; Michael McKenzie ; F.R.C.P.C.^&lowast ; ; Gary Redekop ; F.R.C.S.C.^&Dagger ; ; Fred Hsu ; F.R.C.P.C.^&sect ; ; Ermias Gete ; Ph.D.^&dagger ; ; Brad Gill ; M.Sc.^&dagger ; ; Richard Lee ; Ph.D.^&dagger ; ; Kurt Luchka ; M.Sc.^&dagger ; ; Charles Haw ; F.R.C.S.C.^&Dagger ; ; Andrew Lee ; F.R.C.S.C.^鈥?/sup> ; Brian Toyota ; F.R.C.S.C.^&Dagger ; ; Montgomery Martin ; F.R.C.P.C.^&para ;
• 关键词：Arteriovenous malformation ; Stereotactic radiosurgery ; Symptomatic radiation injury ; Predictive factors
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：1 July, 2012
• 卷：83
• 期：3
• 页码：872-877
• 文件大小：313 K

摘要

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class="h4">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).

class="h4">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.

class="h4">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_x for doses 鈮? Gy showed statistical significance. Only lesion diameter showed statistical significance (p聽< 0.05) in a multivariate model. According to the log-rank test, AVM volumes >5 cm³ and diameters >30 mm were significantly associated with the risk of radiation injury (p < 0.01). The V₁₂ also showed strong association with the incidence of radiation injury. Actuarial incidence of radiation injury was 16.8%if V₁₂ was <28 cm³ and 53.2%if >28 cm³ (log-rank test, p = 0.001).

class="h4">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.