Immediate Side Effects of Cranial Stereotactic Radiosurgery and ...
Immediate Side Effects of Cranial Stereotactic Radiosurgery and ...
Immediate Side Effects of Cranial Stereotactic Radiosurgery and ...
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328 <strong>Immediate</strong> <strong>Side</strong> <strong>Effects</strong> <strong>of</strong> <strong>Cranial</strong> <strong>Stereotactic</strong> <strong>Radiosurgery</strong>experienced nausea <strong>and</strong> vomiting as immediateside effects <strong>of</strong> cranial streotactic irradiation, ahighly significant positive correlation with thedose delivered to the region harboring areapotrema (Vomiting Center) with cut <strong>of</strong>f point at2 Gy was found. After 2 Gy dose, all patientsTable (1): Post-radiosurgery injury expression (PIE) scoresfor location <strong>of</strong> arteriovenous malformation (Flickingeret al., 1997) [10].developed nausea <strong>and</strong> vomiting (Pearson’s ChiSquare) (p value < 0.0001) [3] as shown in Table(11). Poor correlation data were obtained onanalyzing other encountered immediate sideeffects in relation to any <strong>of</strong> the disease or therapyrelated parameters.Table (4): Karn<strong>of</strong>sky performance scale among 163 patientstreated by stereotactic radiosurgery <strong>and</strong> radiotherapy(NEMROCK 1999-2002).PIE scoreLocationPerformance statusNumber%1 (Low risk)234 (High risk)Frontal lobeCerebellum, temporal lobe, partietal lobeOccipital lobe or basal gangliaMedulla, thalamus, intraventricular, ponsor corpus callosum100-9080-7060-50Total65712716339.843.616.6100Table (2): Radiation therapy oncology group (RTOG)radiosurgery quality assurance guidelines [15].Per protocolMinor(acceptabledeviation)Major(unacceptableConformity≤ 2> 2 & < 2.5> 2.5Dosehomogenity1-2> 0.9 & < 1or> 2 & < 2.5< 0.9 & > 2.5Dosegradient≥ 0.3–Conformity: Prescription Isodose Surface Volume to Target Volume(TV) Ratio.Dose homogenity: Maximum Dose (MD) to Prescription Dose(PD) Ratio.Dose gradient: Target Volume (TV) to Volume Enclosed by 50%(V50%) Ratio.Table (3): Initial diagnosis among 163 patients treated bystereotactic radiosurgery <strong>and</strong> radiotherapy (NEM-ROCK 1999-2002).CatgeoryBenignDiseasesTumorsTotalDiagnosisMeningiomasArteriovenousMalformationsAcuosticNeuromasLow gradeGliomasHigh gradeGliomasPituitaryAdenomasMetastaticBrain diseaseOthers*Number2922*Others include; haemangiopericytoma in 2 patients (1%), chordoma<strong>of</strong> skull base in 4 patients (2%), ependymoma in 4 patients(2%), pineal body tumor in 3 patients (1.5%), glomus jugularein 3 patients (1.5%) <strong>and</strong> medulloblastoma in 3 patients (1.5%).2139208519163–1913132812.553%9.5100Table (5): Lesion volume, multiplicity <strong>and</strong> treatment scheduleamong 163 patients treated by stereotacticradiosurgery <strong>and</strong> radiotherapy (NEMROCK1999-2002).ItemVolume:Range (cc)Median volume (cc)St<strong>and</strong>ard deviationMultiplicity:One lesionTwo lesionsThree lesionsTreatment schedule:SRSSRTValues0.21-65.3112.5±13.6160 patients2 patients1 patient101 (61.9%)62 (38.1%)Table (6): Dose scheme adopted among (101) patientstreated by stereotactic radiosurgery (NEM-ROCK 1999-2002).Volume< 1 cc1-5 cc> 5-125 ccN113357% Dose (Gy)10.932.756.4201510Table (7): Dose contribution to risk structures <strong>and</strong> conformityindex among 163 patients treated by stereotacticradiosurgery <strong>and</strong> radiotherapy (NEMROCK1999-2002).RiskstructureLeft eyeRight eyeBrain stemChiasmaConformityIndexDose range(Gy)0-4.40-3.60-19.40-17.2Range1-2.95Mean dose(Gy)0.470.424.601.30Mean value1.44St<strong>and</strong>arddeviation±0.75±0.59±4.84±4.08St<strong>and</strong>ardDeviation±0.39
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