scholarly journals Magnetic resonance imaging detected radiation-induced changes in patients with proton radiation-treated arteriovenous malformations

2021 ◽  
Vol 10 (10) ◽  
pp. 205846012110508
Author(s):  
Maria Correia de Verdier ◽  
Elisabeth Ronne-Engström ◽  
Ljubisa Borota ◽  
Kristina Nilsson ◽  
Erik Blomquist ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Contrast Enhancement ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Vasogenic Edema ◽  
Post Treatment ◽  
Proton Radiation ◽  
Radiation Induced ◽  
Mri Changes ◽  
Induced Changes

Background Treatment of intracranial arteriovenous malformations (AVMs) includes surgery, radiation therapy, endovascular occlusion, or a combination. Proton radiation therapy enables very focused radiation, minimizing dose to the surrounding brain. Purpose To evaluate the presence of radiation-induced changes on post-treatment MRI in patients with AVMs treated with proton radiation and to compare these with development of symptoms and nidus obliteration. Material and Methods Retrospective review of pre- and post-treatment digital subtraction angiography and MRI and medical records in 30 patients with AVMs treated with proton radiation. Patients were treated with two or five fractions; total radiation dose was 20–35 physical Gy. Vasogenic edema (minimal, perinidal, or severe), contrast enhancement (minimal or annular), cavitation and nidus obliteration (total, partial, or none) were assessed. Results 26 of 30 patients (87%) developed MRI changes. Vasogenic edema was seen in 25 of 30 (83%), abnormal contrast enhancement in 18 of 26 (69%) and cavitation in 5 of 30 (17%). Time from treatment to appearance of MRI changes varied between 5 and 25 months (median 7, mean 10). Seven patients developed new or deteriorating symptoms that required treatment with corticosteroids; all these patients had extensive MRI changes (severe vasogenic edema and annular contrast enhancement). Not all patients with extensive MRI changes developed symptoms. We found no relation between MRI changes and nidus obliteration. Conclusion Radiation-induced MRI changes are seen in a majority of patients after proton radiation treatment of AVMs. Extensive MRI changes are associated with new or deteriorating symptoms.

Radiation-induced Changes in MR Signal Intensity and Contrast Enhancement of Lumbosacral Vertebrae: Do Changes Occur Only Inside the Radiation Therapy Field?

Radiology ◽  
2002 ◽  
Vol 222 (1) ◽  
pp. 179-183 ◽  
Author(s):  
Shoichiro Otake ◽  
Nina A. Mayr ◽  
Toshihiro Ueda ◽  
Vincent A. Magnotta ◽  
William T. C. Yuh
Keyword(s):  
Radiation Therapy ◽  
Contrast Enhancement ◽  
Signal Intensity ◽  
Radiation Induced ◽  
Therapy Field ◽  
Induced Changes

Abstract 127: Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ching-jen Chen ◽  
Cheng-Chia Lee ◽  
Hideyuki Kano ◽  
Kathryn Kearns ◽  
Dale Ding ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Arteriovenous Malformations ◽  
Pediatric Population ◽  
Study Cohort ◽  
Brain Arteriovenous Malformations ◽  
History Of ◽  
Radiation Induced ◽  
Induced Changes ◽  
Pediatric Brain ◽  
Stroke Death

Background and Purpose: To evaluate, in a multicenter, retrospective cohort study, the outcomes after stereotactic radiosurgery (SRS) for unruptured, intervention-naïve pediatric brain arteriovenous malformations (AVM). Methods: We retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database from 1987-2018. Pediatric patients with unruptured, previously untreated AVMs who underwent SRS were included. The primary endpoint was a composite of hemorrhagic stroke, death, or permanently symptomatic radiation-induced changes (RIC). Results: The study cohort comprised 101 patients (mean follow-up 80.8 months). The primary endpoint occurred in 14%, comprising hemorrhage stroke, death, and permanent RIC in 6%, 3%, and 8%, respectively. Estimated probabilities of the primary endpoint were 5.2%, 10.8%, and 23.0% at 2, 5, and 10 years, respectively (Figure 1). Estimated probabilities of AVM obliteration at 5 and 10 years were 64% and 82%, respectively (Figure 2). Single SRS treatment (p=0.007) and higher margin dose (p=0.005) were predictors of obliteration. Subgroup analysis of Spetzler-Martin grade I-III AVMs estimated primary endpoint probabilities of 3.7%, 8.4%, and 18.7% at 2, 5 and 10 years, respectively. Conclusion: Treatment of unruptured, intervention-naïve AVMs in the pediatric population with SRS carries an approximately 2% annual risk of morbidity and mortality, which appears to plateau after 10 years. The poorly described natural history of pediatric AVMs makes any comparison of SRS versus conservative management imperfect. However, due to the young age at diagnosis and excessive cumulative life hemorrhage risk of an untreated AVM in a child, SRS is likely to have a favorable long-term risk-benefit profile for appropriately selected unruptured pediatric AVMs.

Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations

Neurosurgery ◽  
2020 ◽  
Vol 87 (2) ◽  
pp. 368-376
Author(s):  
Ching-Jen Chen ◽  
Cheng-Chia Lee ◽  
Hideyuki Kano ◽  
Kathryn N Kearns ◽  
Dale Ding ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Arteriovenous Malformations ◽  
Hemorrhagic Stroke ◽  
Pediatric Population ◽  
Study Cohort ◽  
Brain Arteriovenous Malformations ◽  
Radiation Induced ◽  
Induced Changes ◽  
Pediatric Brain ◽  
Stroke Death

Abstract BACKGROUND Long-term data regarding stereotactic radiosurgery (SRS) as a standalone therapy for unruptured pediatric brain arteriovenous malformations (AVMs) are incompletely defined. OBJECTIVE To evaluate, in a multicenter, retrospective cohort study, the outcomes after SRS for unruptured, intervention-naïve pediatric AVMs. METHODS To retrospectively analyze the International Radiosurgery Research Foundation pediatric AVM database from 1987 to 2018. Pediatric patients with unruptured, previously untreated AVMs who underwent SRS were included. The primary endpoint was a composite of hemorrhagic stroke, death, or permanently symptomatic radiation-induced changes. RESULTS The study cohort comprised 101 patients (mean follow-up 80.8 mo). The primary endpoint occurred in 14%, comprising hemorrhagic stroke, death, and permanent radiation-induced changes in 6%, 3%, and 8%, respectively. Estimated probabilities of the primary endpoint were 5.2%, 10.8%, and 23.0% at 2, 5, and 10 yr, respectively. Estimated probabilities of AVM obliteration at 5 and 10 yr were 64% and 82%, respectively. Single SRS treatment (P = .007) and higher margin dose (P = .005) were predictors of obliteration. Subgroup analysis of Spetzler-Martin grade I-III AVMs estimated primary endpoint probabilities of 3.7%, 8.4%, and 18.7% at 2, 5, and 10 yr, respectively. CONCLUSION Treatment of unruptured, intervention-naïve AVMs in the pediatric population with SRS carries an approximately 2% annual risk of morbidity and mortality, which appears to plateau after 10 yr. The poorly described natural history of pediatric AVMs renders any comparison of SRS vs conservative management imperfect.

scholarly journals Repeat Gamma Knife Surgery for Incompletely Obliterated Cerebral Arteriovenous Malformations

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Chun-Po Yen ◽  
Surbhi Jain ◽  
Iftikhar-ul Haq ◽  
Jay Jagannathan ◽  
David Schlesinger ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Cerebral Arteriovenous Malformations ◽  
Radiation Induced ◽  
Induced Changes

Abstract OBJECTIVE The causes of failure after an initial Gamma procedure were studied, along with imaging and clinical outcomes, in a series of 140 patients with cerebral arteriovenous malformations (AVMs) treated with repeat Gamma Knife surgery (GKS). METHODS Causes of initial treatment failure included inaccurate nidus definition in 14 patients, failure to fill part of the nidus as a result of hemodynamic factors in 16, recanalization of embolized AVM compartments in 6, and suboptimal dose (< 20 Gy) in 23. Nineteen patients had repeat GKS for subtotal obliteration of AVMs. In 62 patients, the AVM failed to obliterate despite correct target definition and adequate dose. At the time of retreatment, the nidus volume ranged from 0.1 to 6.9 cm3 (mean, 1.4 cm3), and the mean prescription dose was 20.3 Gy. RESULTS Repeat GKS yielded a total angiographic obliteration in 77 patients (55%) and subtotal obliteration in 9 (6.4%). In 38 patients (27.1%), the AVMs remained patent, and in 16 patients (11.4%), no flow voids were observed on magnetic resonance imaging. Clinically, 126 patients improved or remained stable, and 14 experienced deterioration (8 resulting from a rebleed, 2 caused by persistent arteriovenous shunting, and 4 related to radiation-induced changes). CONCLUSION By using repeat GKS, we achieved a 55% angiographic cure rate. Although radiation-induced changes as visualized on magnetic resonance imaging occurred in 48 patients (39%), only 4 patients (3.6%) developed permanent neurological deficits. These findings may be useful in deciding the management of AVMs in whom total obliteration after initial GKS was not achieved.

Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck cancers treated with intensity modulated radiation therapy (IMRT)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16513-16513 ◽  
Author(s):  
V. Bar Ad ◽  
S. Both ◽  
P. Dutta ◽  
H. Quon
Keyword(s):  
Radiation Therapy ◽  
Retrospective Study ◽  
Head And Neck ◽  
Pain Control ◽  
Radiation Treatment ◽  
Pain Medication ◽  
Head And Neck Cancers ◽  
Median Dose ◽  
Concomitant Boost ◽  
Radiation Induced

16513 Background: Gabapentin has been reported to effectively treat multiple neuropathic pain syndromes. This retrospective study evaluates the efficacy of gabapentin for the treatment of pain related to radiation induced mucositis, in patients with head and neck cancers, treated with radiation therapy (RT). Methods: This retrospective study includes 30 pts with head and neck cancers, treated with RT, without concomitant or induction chemotherapy. IMRT planning was performed using a concomitant boost technique with a median dose of 54 Gy, 63 Gy, and 66 Gy delivered to the low risk clinical tumor volume (CTV), high risk CTV and boost target volume, respectively, using 30- 34 fractions. The dose of gabapentin was gradually increased starting on the second week of RT from 600 mg/day to the dose of 2700 mg/d over the course of one week. Narcotic pain medication (Roxicodone) was prescribed as needed. Results: 26 (86%) pts required no pain medication during the first two weeks of RT, despite the presence of grade 1 and/or 2 mucositis in 24 of them. During the third and fourth weeks of RT, 28 (93%) pts were treated with a median dose of 2700 mg/day of gabapentin, with only 3 (10%) pts requiring low dose narcotic pain medication, 15–30 mg/day of Roxicodone, added to gabapentin for adequate pain control, despite grade 2 or higher mucositis in 22 pts. During weeks 5 and 6, 28 (93%) pts continued to be treated with a median dose of 2700 mg/day of gabapentin with only 10 (35%) pts requiring 15–40 mg/day of Roxicodone, in addition to gabapentin for pain control, despite the presence of grade 2 or higher mucositis in 23 pts. Only 3% of the pts in this group had delay in RT delivery. Gabapentin was well tolerated with only 13% of pts experiencing mild side effects (somnolence, nausea, or vomiting), which were managed with reducing the dose or changing the dosing schedule. Conclusions: Gabapentin is effective and well-tolerated for the treatment of mucositis-induced pain related to radiation treatment in patients with head and neck cancers, treated with IMRT. We further demonstrate that the use of gabapentin at doses of 2700 mg per day can reduce or eliminate the need for narcotic pain medication. No significant financial relationships to disclose.

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