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Retrospective analysis of linac-based radiosurgery for arteriovenous malformations and testing of the Flickinger formula in predicting radiation injury

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dc.contributor.authorALSAN ÇETİN, İLKNUR
dc.contributor.authorsCetin, I. A.; Ates, R.; Dhaens, J.; Storme, G.
dc.date.accessioned2022-03-12T18:06:20Z
dc.date.available2022-03-12T18:06:20Z
dc.date.issued2012
dc.description.abstractThe aim of the study was to validate the use of linac-based radiosurgery in arteriovenous malformation (AVM) patients and to predict complications using an integrated logistic formula (ILF) in comparison with clinical outcomes. The results of radiosurgery in 92 AVM patients were examined. All patients were treated with linac-based radiosurgery. Of these, 70 patients were followed for 12-45 months (median, 24 months) and were analyzed. The treated volume varied from 0.09 to 26.95 cm(A3) (median, 2.3 cm(A3)) and the median marginal dose was 20 Gy (range, 10.4-22). The median 12-Gy volume was 9.94 cm(A3) (range, 0.74-60.09 cm(A3)). Patients and lesion characteristics potentially affecting nidus obliteration and excellent outcome were evaluated by performing a log-rank test and univariate and multivariate analyses. The risk for radiation injury (RRI) was calculated with an integrated logistic formula. The predictive power of the RRI was assessed by calculating the area under the receiver operating characteristic (ROC) curve. Follow-up magnetic resonance (MR) angiography revealed complete AVM obliteration in 56 of 70 patients. The MR angiography confirmed an obliteration rate of 80%. The annual hemorrhage rate was 1.4% for the first 2 years after radiosurgery and 0% thereafter. The number of patients with an excellent outcome was 48 (68%). Factors associated with better obliteration were higher radiation dose to the lesion margins [12-Gy volume (V12) > 10 cm(A3)], small volume, and a Pollock-Flickinger score less than 1.49; those predicting excellent outcomes were V12 < 10 cm(A3), small volume, and Pollock-Flickinger score less than 1.49, as determined by multivariate analyses. Factors associated with radiation injury were V12 > 10 cm(A3) (p=0.03) and volume greater than 2 cm(A3) (p=0.001), as determined by a univariate analysis. The analyses showed an ROC of 0.66. These data suggest that linac-based radiosurgery is effective. In terms of obliteration, excellent outcomes, and especially radiation injury, V12 and volume should be considered. The Flickinger formula seems to be applicable to Novalis-treated patients, but long-term follow-up is necessary for definite conclusions.
dc.identifier.doi10.1007/s00066-012-0180-6
dc.identifier.eissn1439-099X
dc.identifier.issn0179-7158
dc.identifier.pubmed23128895
dc.identifier.urihttps://hdl.handle.net/11424/230884
dc.identifier.wosWOS:000311667800012
dc.language.isoeng
dc.publisherSPRINGER HEIDELBERG
dc.relation.ispartofSTRAHLENTHERAPIE UND ONKOLOGIE
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectArteriovenous malformation
dc.subjectOutcome
dc.subjectRisk of radiation injury
dc.subjectStereotactic radiosurgery
dc.subjectLinac
dc.subjectGAMMA-KNIFE RADIOSURGERY
dc.subjectLINEAR-ACCELERATOR RADIOSURGERY
dc.subjectSTEREOTACTIC RADIOSURGERY
dc.subjectGRADING SYSTEM
dc.subjectDOSE-RESPONSE
dc.subjectCOMPLICATIONS
dc.subjectRISK
dc.subjectOBLITERATION
dc.subjectHEMORRHAGE
dc.subjectMANAGEMENT
dc.titleRetrospective analysis of linac-based radiosurgery for arteriovenous malformations and testing of the Flickinger formula in predicting radiation injury
dc.typearticle
dspace.entity.typePublication
local.avesis.ide8c22577-0dc2-40e0-8612-6bca84a838d6
local.import.packageSS17
local.indexed.atWOS
local.indexed.atSCOPUS
local.journal.numberofpages6
oaire.citation.endPage1138
oaire.citation.issue12
oaire.citation.startPage1133
oaire.citation.titleSTRAHLENTHERAPIE UND ONKOLOGIE
oaire.citation.volume188
relation.isAuthorOfPublicationfab5ec4d-b078-4832-a240-29c00f3c424c
relation.isAuthorOfPublication.latestForDiscoveryfab5ec4d-b078-4832-a240-29c00f3c424c

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