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Pre- and Posttherapy Risk Factors for Vasculopathy in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Radiation Therapy.

Authors
  • Lucas, John T Jr1
  • Faught, Austin M2
  • Hsu, Chih Yang3
  • Wilson, Lydia J2
  • Guo, Yian4
  • Li, Yimei4
  • Khan, Raja5
  • Becksfort, Jared B2
  • LeVine, David A6
  • Ismael, Yousef2
  • Darrow, Kaleb6
  • Moskvin, Vadim P2
  • Pirlepesov, Fakhriddin2
  • Klimo, Paul7
  • Elijovich, Lucas8
  • Indelicato, Daniel J9
  • Boop, Fredrick A7
  • Merchant, Thomas E2
  • 1 Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: [email protected]
  • 2 Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • 3 GlaxoSmithKline, Exton, Pennsylvania.
  • 4 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • 5 Department of Neurology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • 6 University of Tennessee Health Sciences Center, Memphis, Tennessee.
  • 7 Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
  • 8 Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee; Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
  • 9 Department of Radiation Oncology, University of Florida, Jacksonville, Florida.
Type
Published Article
Journal
International journal of radiation oncology, biology, physics
Publication Date
May 01, 2022
Volume
113
Issue
1
Pages
152–160
Identifiers
DOI: 10.1016/j.ijrobp.2021.12.172
PMID: 34990778
Source
Medline
Language
English
License
Unknown

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. Copyright © 2021 Elsevier Inc. All rights reserved.

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