Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort

Jeremy K. Cutsforth-Gregory, Giuseppe Lanzino, Michael J. Link, Robert D Jr. Brown, Kelly Flemming

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

OBJECT: The objective of this study was to characterize the clinical features of radiation-induced cavernous malformations (RICMs).

METHODS: The authors retrospectively reviewed the clinical and radiological characteristics of patients with RICMs. The features of these RICMs were then compared with features of nonradiation cavernous malformations (CMs) in 270 patients.

RESULTS: Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0-19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118).

CONCLUSIONS: In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage.

Original languageEnglish (US)
Pages (from-to)1214-1222
Number of pages9
JournalJournal of Neurosurgery
Volume122
Issue number5
DOIs
StatePublished - May 1 2015

Keywords

  • cavernous angioma
  • cavernous malformation
  • CM = cavernous malformation
  • GRE = gradient echo
  • hemorrhage
  • mRS = modified Rankin Scale
  • radiation
  • RICM = radiation-induced CM
  • RIT = radiation-induced telangiectasia
  • SWI = susceptibility-weighted imaging
  • vascular disorders

ASJC Scopus subject areas

  • Medicine(all)

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