Journal article
Pre- and Posttherapy Risk Factors for Vasculopathy in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Radiation Therapy
International journal of radiation oncology, biology, physics, Vol.113(1), pp.152-160
05/01/2022
DOI: 10.1016/j.ijrobp.2021.12.172
PMCID: PMC9018579
PMID: 34990778
Abstract
Vasculopathy (VAS) is a significant complication associated with radiation therapy in patients treated for brain tumors. We studied the type, location, severity, timing, and resolution of VAS in children with craniopharyngioma treated with proton radiation therapy (PRT) and evaluated predictors of stenosis (STN) using a novel patient and imaging-based modeling approach.
Children with craniopharyngioma (n = 94) were treated with 54 Gy relative biological effectiveness PRT in a clinical trial, NCT01419067. We evaluated VAS type, location, severity, and resolution. VAS events were segmented and related to their location, operative corridor, PRT dose, and vascular territory to facilitate mixed effect logistic regression modeling of spatial predictors of STN events.
Forty-five (47.9%) patients had 111 instances of confirmed VAS (pre-PRT n = 37, 33.3%). The median time to post-PRT VAS was 3.41 years (95% confidence interval, 1.86-6.11). STN events were observed post-PRT in 23.4% (n = 22) of patients. Post-PRT VAS was detected by cerebral angiogram in 9.6% (n = 9), severe in 4.3% (n = 4), and compensated on perfusion in 2.1% (n = 2). Revascularization was required for 5 (5.3%) patients. Postsurgical, pre-PRT VAS, and PRT dose to unperturbed vessels were predictive of STN. The effect of PRT on STN was negligible within the surgical corridor.
VAS often precedes PRT and was the strongest predictor of post-PRT STN. The adverse effect of PRT on STN was only apparent in unperturbed vasculature beyond the operative corridor.
Details
- Title: Subtitle
- Pre- and Posttherapy Risk Factors for Vasculopathy in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Radiation Therapy
- Creators
- John T Lucas Jr - Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: john.lucas@stjude.orgAustin M Faught - St. Jude Children's Research HospitalChih Yang Hsu - GlaxoSmithKline, 812 Springdale Drive, Exton, PA 19341Lydia J Wilson - St. Jude Children's Research HospitalYian Guo - St. Jude Children's Research HospitalYimei Li - St. Jude Children's Research HospitalRaja Khan - St. Jude Children's Research HospitalJared B Becksfort - St. Jude Children's Research HospitalDavid A LeVine - University of Tennessee at KnoxvilleYousef Ismael - St. Jude Children's Research HospitalKaleb Darrow - University of Tennessee at KnoxvilleVadim P Moskvin - St. Jude Children's Research HospitalFakhriddin Pirlepesov - St. Jude Children's Research HospitalPaul Klimo - University of Tennessee Health Science CenterLucas Elijovich - Department of Neurology, University of TN Health Sciences Center, 847 Monroe Avenue, Suite 226, Memphis, TN 38163Daniel J Indelicato - Department of Radiation Oncology, University of Florida, Jacksonville, FL 32206Fredrick A Boop - University of Tennessee Health Science CenterThomas E Merchant - St. Jude Children's Research Hospital
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.113(1), pp.152-160
- DOI
- 10.1016/j.ijrobp.2021.12.172
- PMID
- 34990778
- PMCID
- PMC9018579
- NLM abbreviation
- Int J Radiat Oncol Biol Phys
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Grant note
- R25 CA023944 / NCI NIH HHS P30 CA021765 / NCI NIH HHS
- Language
- English
- Date published
- 05/01/2022
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984312969202771
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