TY - JOUR
T1 - Increased risk for ex-vacuo ventriculomegaly with leukoencephalopathy (EVL) in whole brain radiation therapy and repeat radiosurgery treated brain metastasis patients
AU - Alattar, Ali A.
AU - Dhawan, Sanjay
AU - Bartek, Jiri
AU - Carroll, Kate
AU - Ma, Jun
AU - Sanghvi, Parag
AU - Chen, Clark C.
N1 - Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/9
Y1 - 2023/9
N2 - 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 had > 3 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 (OR = 5.08, p < 0.001). In bivariate models that included prior receipt of WBRT, both the number of SRS treatments (OR = 1.499, p = 0.025) and WBRT (OR = 11.321, p = 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 ∼20-fold lower than that associated with WBRT.
AB - 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 had > 3 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 (OR = 5.08, p < 0.001). In bivariate models that included prior receipt of WBRT, both the number of SRS treatments (OR = 1.499, p = 0.025) and WBRT (OR = 11.321, p = 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 ∼20-fold lower than that associated with WBRT.
KW - Brain metastases
KW - Radiosurgery
KW - Stereotactic
KW - Ventriculomegaly
KW - White matter changes
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U2 - 10.1016/j.jocn.2023.07.005
DO - 10.1016/j.jocn.2023.07.005
M3 - Article
C2 - 37541084
AN - SCOPUS:85166652785
SN - 0967-5868
VL - 115
SP - 95
EP - 100
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -