Increased risk for ex-vacuo ventriculomegaly with leukoencephalopathy (EVL) in whole brain radiation therapy and repeat radiosurgery treated brain metastasis patients.
J Clin Neurosci
; 115: 95-100, 2023 Sep.
Article
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| MEDLINE
| ID: mdl-37541084
ABSTRACT
INTRODUCTION:
Cerebral atrophy with leukoencephalopathy is a known morbidity after whole brain radiation therapy (WBRT), resulting in ex-vacuo ventriculomegaly with leukoencephalopathy (EVL). Here we studied the correlation between WBRT, stereotactic radiosurgery (SRS), and risk for EVL in brain metastases patients.METHODS:
In a retrospective study, we identified 195 patients (with 1,018 BM) who underwent SRS for BM (2007-2017) and hadâ¯>â¯3â¯months of MRI follow-up. All patients who underwent ventriculoperitoneal shunting were excluded. Cerebral atrophy was measured by ex-vacuo-ventriculomegaly, defined based on Evans' criteria. Demographic and clinical variables were analyzed using logistic regression models.RESULTS:
Ex-vacuo ventriculomegaly was observed on pre-radiosurgery imaging in 29.7% (58/195) of the study cohort. On multivariate analysis, older age was the only variable associated with pre-radiosurgery ventriculomegaly. Of the 137 patients with normal ventricular size before radiosurgery, 27 (19.7 %) developed ex-vacuo ventriculomegaly and leukoencephalopathy (EVL) post-SRS. In univariate analysis, previous whole brain radiation therapy was the main factor associated with increased risk for developing EVL (ORâ¯=â¯5.08, pâ¯<â¯0.001). In bivariate models that included prior receipt of WBRT, both the number of SRS treatments (ORâ¯=â¯1.499, pâ¯=â¯0.025) and WBRT (ORâ¯=â¯11.321, pâ¯=â¯0.003 were independently associated with increased EVL risk.CONCLUSIONS:
While repeat radiosurgery contributes to the risk of EVL in BM patients, this risk is â¼20-fold lower than that associated with WBRT.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Encefálicas
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Radiocirugia
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Leucoencefalopatías
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Hidrocefalia
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
J Clin Neurosci
Asunto de la revista:
NEUROLOGIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos