Incidence and management of late adverse radiation effects after arteriovenous malformation radiosurgery

Bruce E. Pollock, Michael J. Link, Megan E. Branda, Curtis Storlie

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Late adverse radiation effects (ARE) typically occur many years after stereotactic radiosurgery (SRS) of intracranial arteriovenous malformations (AVM). They are characterized by perilesional edema or cyst formation and are distinct from radiationinduced changes (RIC) noted in the first 1 to 2 years after AVM SRS and radiation necrosis. Objective: To determine the incidence of late ARE after AVM SRS. Methods: Retrospective review of 233 AVM patients having SRS from 1990 to 2009. Patients had sporadic AVM, no prior radiation, and a minimum of 5 years of magnetic resonance imaging (MRI) follow-up. The median MRI follow-up after SRS was 9.8 years (range, 5-24.2). Results: Late ARE were observed in 16 patients (6.9%) at a median of 8.7 years after SRS (range, 2.0-16.1). The 5-, 10-, and 15-year incidence of late ARE was 0.4%, 7.7%, and 12.5%, respectively. Eight patients (3.4%) were symptomatic at the time of ARE detection. Three of 8 patients who were initially asymptomatic had documented cyst progression (at 11, 40, and 42 months), for an overall symptomatic rate of 4.7%. Five patients with asymptomatic ARE have been observed for a median of 9.3 years (range, 2.0-14.1) without progression. Patients having early RIC (hazard ratio [HR] = 2.11, P < .001), patients having obliteration (HR=1.24, P=.02), and patients having SRS before April 1997 (HR=1.12, P=.02) weremore likely to develop late ARE. Conclusion: Late ARE are common in AVM patients who develop early RIC after SRS. Resection of the thrombosed AVM and the adjacent damaged tissue is effective at eliminating the mass effect and improving patients' neurological condition.

Original languageEnglish (US)
Pages (from-to)928-934
Number of pages7
JournalClinical Neurosurgery
Volume81
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Radiosurgery
Arteriovenous Malformations
Radiation Effects
Incidence
Cysts
Magnetic Resonance Imaging
Radiation
Intracranial Arteriovenous Malformations
Edema
Thrombosis
Necrosis

Keywords

  • Arteriovenous malformation
  • Complication
  • Cyst
  • Edema
  • Radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Incidence and management of late adverse radiation effects after arteriovenous malformation radiosurgery. / Pollock, Bruce E.; Link, Michael J.; Branda, Megan E.; Storlie, Curtis.

In: Clinical Neurosurgery, Vol. 81, No. 6, 01.12.2017, p. 928-934.

Research output: Contribution to journalArticle

Pollock, Bruce E. ; Link, Michael J. ; Branda, Megan E. ; Storlie, Curtis. / Incidence and management of late adverse radiation effects after arteriovenous malformation radiosurgery. In: Clinical Neurosurgery. 2017 ; Vol. 81, No. 6. pp. 928-934.
@article{18b1523d4c85461d8488e029ad91c634,
title = "Incidence and management of late adverse radiation effects after arteriovenous malformation radiosurgery",
abstract = "Background: Late adverse radiation effects (ARE) typically occur many years after stereotactic radiosurgery (SRS) of intracranial arteriovenous malformations (AVM). They are characterized by perilesional edema or cyst formation and are distinct from radiationinduced changes (RIC) noted in the first 1 to 2 years after AVM SRS and radiation necrosis. Objective: To determine the incidence of late ARE after AVM SRS. Methods: Retrospective review of 233 AVM patients having SRS from 1990 to 2009. Patients had sporadic AVM, no prior radiation, and a minimum of 5 years of magnetic resonance imaging (MRI) follow-up. The median MRI follow-up after SRS was 9.8 years (range, 5-24.2). Results: Late ARE were observed in 16 patients (6.9{\%}) at a median of 8.7 years after SRS (range, 2.0-16.1). The 5-, 10-, and 15-year incidence of late ARE was 0.4{\%}, 7.7{\%}, and 12.5{\%}, respectively. Eight patients (3.4{\%}) were symptomatic at the time of ARE detection. Three of 8 patients who were initially asymptomatic had documented cyst progression (at 11, 40, and 42 months), for an overall symptomatic rate of 4.7{\%}. Five patients with asymptomatic ARE have been observed for a median of 9.3 years (range, 2.0-14.1) without progression. Patients having early RIC (hazard ratio [HR] = 2.11, P < .001), patients having obliteration (HR=1.24, P=.02), and patients having SRS before April 1997 (HR=1.12, P=.02) weremore likely to develop late ARE. Conclusion: Late ARE are common in AVM patients who develop early RIC after SRS. Resection of the thrombosed AVM and the adjacent damaged tissue is effective at eliminating the mass effect and improving patients' neurological condition.",
keywords = "Arteriovenous malformation, Complication, Cyst, Edema, Radiosurgery",
author = "Pollock, {Bruce E.} and Link, {Michael J.} and Branda, {Megan E.} and Curtis Storlie",
year = "2017",
month = "12",
day = "1",
doi = "10.1093/neuros/nyx010",
language = "English (US)",
volume = "81",
pages = "928--934",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Incidence and management of late adverse radiation effects after arteriovenous malformation radiosurgery

AU - Pollock, Bruce E.

AU - Link, Michael J.

AU - Branda, Megan E.

AU - Storlie, Curtis

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: Late adverse radiation effects (ARE) typically occur many years after stereotactic radiosurgery (SRS) of intracranial arteriovenous malformations (AVM). They are characterized by perilesional edema or cyst formation and are distinct from radiationinduced changes (RIC) noted in the first 1 to 2 years after AVM SRS and radiation necrosis. Objective: To determine the incidence of late ARE after AVM SRS. Methods: Retrospective review of 233 AVM patients having SRS from 1990 to 2009. Patients had sporadic AVM, no prior radiation, and a minimum of 5 years of magnetic resonance imaging (MRI) follow-up. The median MRI follow-up after SRS was 9.8 years (range, 5-24.2). Results: Late ARE were observed in 16 patients (6.9%) at a median of 8.7 years after SRS (range, 2.0-16.1). The 5-, 10-, and 15-year incidence of late ARE was 0.4%, 7.7%, and 12.5%, respectively. Eight patients (3.4%) were symptomatic at the time of ARE detection. Three of 8 patients who were initially asymptomatic had documented cyst progression (at 11, 40, and 42 months), for an overall symptomatic rate of 4.7%. Five patients with asymptomatic ARE have been observed for a median of 9.3 years (range, 2.0-14.1) without progression. Patients having early RIC (hazard ratio [HR] = 2.11, P < .001), patients having obliteration (HR=1.24, P=.02), and patients having SRS before April 1997 (HR=1.12, P=.02) weremore likely to develop late ARE. Conclusion: Late ARE are common in AVM patients who develop early RIC after SRS. Resection of the thrombosed AVM and the adjacent damaged tissue is effective at eliminating the mass effect and improving patients' neurological condition.

AB - Background: Late adverse radiation effects (ARE) typically occur many years after stereotactic radiosurgery (SRS) of intracranial arteriovenous malformations (AVM). They are characterized by perilesional edema or cyst formation and are distinct from radiationinduced changes (RIC) noted in the first 1 to 2 years after AVM SRS and radiation necrosis. Objective: To determine the incidence of late ARE after AVM SRS. Methods: Retrospective review of 233 AVM patients having SRS from 1990 to 2009. Patients had sporadic AVM, no prior radiation, and a minimum of 5 years of magnetic resonance imaging (MRI) follow-up. The median MRI follow-up after SRS was 9.8 years (range, 5-24.2). Results: Late ARE were observed in 16 patients (6.9%) at a median of 8.7 years after SRS (range, 2.0-16.1). The 5-, 10-, and 15-year incidence of late ARE was 0.4%, 7.7%, and 12.5%, respectively. Eight patients (3.4%) were symptomatic at the time of ARE detection. Three of 8 patients who were initially asymptomatic had documented cyst progression (at 11, 40, and 42 months), for an overall symptomatic rate of 4.7%. Five patients with asymptomatic ARE have been observed for a median of 9.3 years (range, 2.0-14.1) without progression. Patients having early RIC (hazard ratio [HR] = 2.11, P < .001), patients having obliteration (HR=1.24, P=.02), and patients having SRS before April 1997 (HR=1.12, P=.02) weremore likely to develop late ARE. Conclusion: Late ARE are common in AVM patients who develop early RIC after SRS. Resection of the thrombosed AVM and the adjacent damaged tissue is effective at eliminating the mass effect and improving patients' neurological condition.

KW - Arteriovenous malformation

KW - Complication

KW - Cyst

KW - Edema

KW - Radiosurgery

UR - http://www.scopus.com/inward/record.url?scp=85042141655&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042141655&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyx010

DO - 10.1093/neuros/nyx010

M3 - Article

C2 - 28328005

AN - SCOPUS:85042141655

VL - 81

SP - 928

EP - 934

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 6

ER -