Age-Dependent Hemorrhage Risk and Obliteration Benefit After Radiosurgery for Brain Arteriovenous Malformation

Yuki Shinya; Hirotaka Hasegawa; Masahiro Shin; Kosuke Kashiwabara; Mariko Kawashima; Shunya Hanakita; Tomoyuki Koga; Satoshi Koizumi; Atsuto Katano; Yuichi Suzuki; Nobuhito Saito

doi:10.1016/j.ijrobp.2023.02.059

Age-Dependent Hemorrhage Risk and Obliteration Benefit After Radiosurgery for Brain Arteriovenous Malformation

Int J Radiat Oncol Biol Phys. 2023 Aug 1;116(5):1126-1134. doi: 10.1016/j.ijrobp.2023.02.059. Epub 2023 Mar 11.

Authors

Affiliations

¹ Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan. Electronic address: yukishinya6155@gmail.com.
² Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
³ Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
⁴ Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, University of Tokyo, Tokyo, Japan.
⁵ Department of Radiology, University of Tokyo Hospital, Tokyo, Japan.

PMID: 36907366
DOI: 10.1016/j.ijrobp.2023.02.059

Abstract

Purpose: Because patients with untreated brain arteriovenous malformations (BAVMs) are at variable risks of cerebral hemorrhage and associated mortality and morbidity, it is essential to identify patient populations who benefit most from prophylactic interventions. This study aimed to examine age-dependent differences in the therapeutic effect of stereotactic radiosurgery (SRS) on BAVMs.

Methods and materials: This retrospective observational study enrolled patients with BAVMs who underwent SRS at our institution between 1990 and 2017. The primary outcome was post-SRS hemorrhage, and the secondary outcomes included nidus obliteration, post-SRS early signal changes, and mortality. To investigate age-related differences in outcomes after SRS, we performed age-stratified analyses using the Kaplan-Meier analysis and weighted logistic regression with the inverse probability of censoring weighting (IPCW). To address significant differences in patient baseline characteristics, we also performed inverse probability of treatment weighting (IPTW) adjusted for possible confounders to investigate age-related differences in outcomes after SRS.

Results: A total of 735 patients with 738 BAVMs were stratified by age. Age-stratified analysis using a weighted logistic regression model with IPCW showed a direct correlation between patient age and post-SRS hemorrhage (odds ratio [OR], 95% confidence interval [CI], and P value: 2.20, 1.34-3.63, and .002 at 18 months; 1.86, 1.17-2.93, and .008 at 36 months; and 1.61, 1.05-2.48, and .030 at 54 months, respectively). The age-stratified analysis also showed an inverse relationship between age and obliteration over the first 42 months after SRS (OR, 95% CI, and P value: 0.05, 0.02-0.12, and <.001 at 6 months; 0.55, 0.44-0.70, and <.001 at 24 months; and 0.76, 0.63-0.91, and .002 at 42 months, respectively). These results were also confirmed with the IPTW analyses.

Conclusions: Our analysis demonstrated that patients' age at SRS is significantly associated with hemorrhage and the nidus obliteration rate after treatment. In particular, younger patients are more likely to exhibit reduced cerebral hemorrhages and achieve earlier nidus obliteration compared with older patients.

Publication types

Observational Study

MeSH terms

Brain
Cerebral Hemorrhage / etiology
Child, Preschool
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations* / complications
Intracranial Arteriovenous Malformations* / radiotherapy
Radiosurgery* / adverse effects
Radiosurgery* / methods
Retrospective Studies
Treatment Outcome