Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis
Objective: The frameless linear accelerator (LINAC) based stereotactic radiosurgery (SRS) has been evolving with a reduction in patient discomfort. However, there was limited evidence comparing frame-based and frameless SRS for intracranial arteriovenous malformations (AVM). We aimed to compare the...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630823000678 |
| _version_ | 1827915218568609792 |
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| author | Zhexi He Man Kit Jason Ho Wan Yan Venus Lee Hing Yuen Law Yee Wa Victy Wong To-wai Leung Wing Ho Mui Sui-To Wong Chi Sing Frank Wong Kwong Yui Yam |
| author_facet | Zhexi He Man Kit Jason Ho Wan Yan Venus Lee Hing Yuen Law Yee Wa Victy Wong To-wai Leung Wing Ho Mui Sui-To Wong Chi Sing Frank Wong Kwong Yui Yam |
| author_sort | Zhexi He |
| collection | DOAJ |
| description | Objective: The frameless linear accelerator (LINAC) based stereotactic radiosurgery (SRS) has been evolving with a reduction in patient discomfort. However, there was limited evidence comparing frame-based and frameless SRS for intracranial arteriovenous malformations (AVM). We aimed to compare the treatment outcomes between frame-based and frameless LINAC SRS. Materials and Methods: This retrospective cohort compared the outcomes of frame-based LINAC SRS (1998–2009) with frameless LINAC SRS (2010–2020). The primary outcome was the obliteration rate. The other outcomes included the neurological, radiological, and functional outcomes after SRS. A matched cohort was identified by propensity scores for further comparisons. Results: A total of 65 patients were included with a mean follow-up time of 13.2 years (158.5 months). There were 40 patients in the frame-based group and 25 patients in the frameless group. The overall obliteration rate was comparable (Frame-based 82.5% vs Frameless 80.0%, p = 0.310) and not significantly different over time (log-rank p = 0.536). The crude post-SRS hemorrhage rate was 1.5% and the incidence was 0.3 per 100 person-years. There were 67.7% of patients with AVM obliteration without new persistent neurological deficits at the last visit and 56.9% of patients with AVM obliteration without any deficits (transient or persistent) during the entire follow-up period. Four patients (8.0%) developed late onset persistent adverse radiation effects (more than 96 months after SRS) among 50 patients with more than 8-year surveillance. In the propensity-matched cohort of 42 patients, there was no significant difference in AVM obliteration (Frame-based vs Frameless, log-rank p = 0.984). Conclusion: Frameless and frame-based LINAC SRS have comparable efficacy in intracranial AVM obliteration. A longer follow-up duration may further characterize the rate of late adverse radiation effects in frameless SRS. |
| first_indexed | 2024-03-13T02:56:22Z |
| format | Article |
| id | doaj.art-479e9797277c498493c2a7951086d696 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-03-13T02:56:22Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-479e9797277c498493c2a7951086d6962023-06-28T04:29:52ZengElsevierClinical and Translational Radiation Oncology2405-63082023-07-0141100642Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysisZhexi He0Man Kit Jason Ho1Wan Yan Venus Lee2Hing Yuen Law3Yee Wa Victy Wong4To-wai Leung5Wing Ho Mui6Sui-To Wong7Chi Sing Frank Wong8Kwong Yui Yam9Department of Neurosurgery, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Neurosurgery, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Clinical Oncology, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Neurosurgery, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Clinical Oncology, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Clinical Oncology, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Clinical Oncology, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Neurosurgery, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Clinical Oncology, Tuen Mun Hospital, N.T., Hong Kong, ChinaDepartment of Neurosurgery, Tuen Mun Hospital, N.T., Hong Kong, China; Corresponding author at: Rm 1012, Block A, Department of Neurosurgery, Tuen Mun Hospital, 23 Tsing Chung Koon Rd, Tuen Mun, New Territories 999077, Hong Kong, China.Objective: The frameless linear accelerator (LINAC) based stereotactic radiosurgery (SRS) has been evolving with a reduction in patient discomfort. However, there was limited evidence comparing frame-based and frameless SRS for intracranial arteriovenous malformations (AVM). We aimed to compare the treatment outcomes between frame-based and frameless LINAC SRS. Materials and Methods: This retrospective cohort compared the outcomes of frame-based LINAC SRS (1998–2009) with frameless LINAC SRS (2010–2020). The primary outcome was the obliteration rate. The other outcomes included the neurological, radiological, and functional outcomes after SRS. A matched cohort was identified by propensity scores for further comparisons. Results: A total of 65 patients were included with a mean follow-up time of 13.2 years (158.5 months). There were 40 patients in the frame-based group and 25 patients in the frameless group. The overall obliteration rate was comparable (Frame-based 82.5% vs Frameless 80.0%, p = 0.310) and not significantly different over time (log-rank p = 0.536). The crude post-SRS hemorrhage rate was 1.5% and the incidence was 0.3 per 100 person-years. There were 67.7% of patients with AVM obliteration without new persistent neurological deficits at the last visit and 56.9% of patients with AVM obliteration without any deficits (transient or persistent) during the entire follow-up period. Four patients (8.0%) developed late onset persistent adverse radiation effects (more than 96 months after SRS) among 50 patients with more than 8-year surveillance. In the propensity-matched cohort of 42 patients, there was no significant difference in AVM obliteration (Frame-based vs Frameless, log-rank p = 0.984). Conclusion: Frameless and frame-based LINAC SRS have comparable efficacy in intracranial AVM obliteration. A longer follow-up duration may further characterize the rate of late adverse radiation effects in frameless SRS.http://www.sciencedirect.com/science/article/pii/S2405630823000678Adverse radiation effectFrameless radiosurgeryIntracranial arteriovenous malformationsObliteration rateLinear acceleratorMask-based radiosurgery |
| spellingShingle | Zhexi He Man Kit Jason Ho Wan Yan Venus Lee Hing Yuen Law Yee Wa Victy Wong To-wai Leung Wing Ho Mui Sui-To Wong Chi Sing Frank Wong Kwong Yui Yam Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis Clinical and Translational Radiation Oncology Adverse radiation effect Frameless radiosurgery Intracranial arteriovenous malformations Obliteration rate Linear accelerator Mask-based radiosurgery |
| title | Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis |
| title_full | Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis |
| title_fullStr | Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis |
| title_full_unstemmed | Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis |
| title_short | Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis |
| title_sort | frameless versus frame based stereotactic radiosurgery for intracranial arteriovenous malformations a propensity matched analysis |
| topic | Adverse radiation effect Frameless radiosurgery Intracranial arteriovenous malformations Obliteration rate Linear accelerator Mask-based radiosurgery |
| url | http://www.sciencedirect.com/science/article/pii/S2405630823000678 |
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