Hemorrhagic Outcome of Brainstem Cavernous Malformations following Radiosurgery: Dose-Response Relationship.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-01-01 Epub Date: 2023-11-23 DOI:10.1159/000534903

Bo-Han Yao, Liang Wang, Pan-Pan Liu, Ze-Yu Wu, Li-Wei Zhang, Jun-Ting Zhang, Zhen Wu, Shi-Bin Sun, Da Li

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引用次数: 0

Abstract

Introduction: This study aimed to assess the impact of gamma knife radiosurgery on brainstem cavernous malformations (CMs).

Methods: A total of 85 patients (35 females; median age 41.0 years) who underwent gamma knife radiosurgery for brainstem CMs at our institute between 2006 and 2015 were enrolled in a prospective clinical observation trial. Risk factors for hemorrhagic outcomes were evaluated, and outcomes were compared across different margin doses.

Results: The pre-radiosurgery annual hemorrhage rate (AHR) was 32.3% (44 hemorrhages during 136.2 patient-years). The median planning target volume was 1.292 cc. The median margin and maximum doses were 15.0 and 29.2 Gy, respectively, with a median isodose line of 50.0%. The post-radiosurgery AHR was 2.7% (21 hemorrhages during 769.9 patient-years), with a rate of 5.5% within the first 2 years and 2.0% thereafter. The post-radiosurgery AHR for patients with margin doses of ≤13.0 Gy (n = 15), 14.0-15.0 Gy (n = 50), and ≥16.0 Gy (n = 20) was 5.4, 2.7, and 0.6%, respectively. Correspondingly, transient adverse radiation effects were observed in 6.7 (1/15), 10.0 (5/50), and 30.0% (6/20) of cases, respectively. An increased margin dose per 1 Gy (hazard ratio: 0.530, 95% CI: 0.341-0.826, p = 0.005) was identified as an independent protective factor against post-radiosurgery hemorrhage. Margin doses of ≥16.0 Gy were associated with improved hemorrhagic outcomes (hazard ratio: 0.343, 95% confidence interval [CI]: 0.157-0.749, p = 0.007), but an increased risk of adverse radiation effects (odds ratio: 3.006, 95% CI: 1.041-8.677, p = 0.042).

Conclusion: The AHR of brainstem CMs decreased following radiosurgery, and our study revealed a significant dose-response relationship. Margin doses of 14-15 Gy were recommended. Further studies are required to validate our findings.

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放射手术后脑干海绵状血管瘤的出血结局:剂量-反应关系。

简介:本研究旨在评估伽玛刀放射治疗脑干海绵状畸形(CMs)的影响。方法:共85例患者(女性35例;2006年至2015年间在我院接受伽玛刀放射治疗脑干CMs的患者纳入前瞻性临床观察试验。评估出血结局的危险因素，并比较不同边缘剂量的结局。结果:放疗前年出血率(AHR)为32.3%(136.2患者-年出血44例)。计划靶体积中位数为1.292 cc，中位边际剂量和最大剂量分别为15.0 Gy和29.2 Gy，中位等剂量线为50.0%。术后AHR为2.7%(769.9患者年出血21例)，其中前2年为5.5%，后2年为2.0%。边缘剂量≤13.0 Gy (n = 15)、14.0 ~ 15.0 Gy (n = 50)和≥16.0 Gy (n = 20)患者的术后AHR分别为5.4、2.7和0.6%。相应的，6.7(1/15)、10.0(5/50)和30.0%(6/20)的病例出现了短暂的辐射不良反应。每1 Gy边缘剂量增加(风险比:0.530,95% CI: 0.341-0.826, p = 0.005)被确定为预防放疗后出血的独立保护因素。≥16.0 Gy的边缘剂量与出血结局的改善相关(风险比:0.343,95%可信区间[CI]: 0.157-0.749, p = 0.007)，但不良辐射效应的风险增加(优势比:3.006,95% CI: 1.041-8.677, p = 0.042)。结论:放疗后脑干cm的AHR降低，且我们的研究显示了显著的剂量-反应关系。建议边际剂量为14-15 Gy。需要进一步的研究来验证我们的发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.