Immediate Side Effects of Cranial Stereotactic Radiosurgery and ...

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328 Immediate Side Effects of Cranial Stereotactic Radiosurgeryexperienced nausea and vomiting as immediateside effects of cranial streotactic irradiation, ahighly significant positive correlation with thedose delivered to the region harboring areapotrema (Vomiting Center) with cut off point at2 Gy was found. After 2 Gy dose, all patientsTable (1): Post-radiosurgery injury expression (PIE) scoresfor location of arteriovenous malformation (Flickingeret al., 1997) [10].developed nausea and 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 of the disease or therapyrelated parameters.Table (4): Karnofsky performance scale among 163 patientstreated by stereotactic radiosurgery and 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 and radiotherapy (NEM-ROCK 1999-2002).CatgeoryBenignDiseasesTumorsTotalDiagnosisMeningiomasArteriovenousMalformationsAcuosticNeuromasLow gradeGliomasHigh gradeGliomasPituitaryAdenomasMetastaticBrain diseaseOthers*Number2922*Others include; haemangiopericytoma in 2 patients (1%), chordomaof 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%) and medulloblastoma in 3 patients (1.5%).2139208519163–1913132812.553%9.5100Table (5): Lesion volume, multiplicity and treatment scheduleamong 163 patients treated by stereotacticradiosurgery and radiotherapy (NEMROCK1999-2002).ItemVolume:Range (cc)Median volume (cc)Standard 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 and conformityindex among 163 patients treated by stereotacticradiosurgery and 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 value1.44Standarddeviation±0.75±0.59±4.84±4.08StandardDeviation±0.39
Mohamad Abdulla 329Table (8): Incidence of immediate side effects “of mild &moderate severity” reported among 163 patientstreated by stereotactic radiosurgery and radiotherapy(NEMROCK 1999-2002).Immediate sideeffectsNaudea and vomitingHeadacheWorsening of pretreat. DeficitsConvulsive fitsNumber of patientswith side effects392352% oftotal23.9143.061.2Table (9): Incidence of immediate side effects accordingto initial diagnosis among 163 patients treatedby stereotactic radiosurgery and radiotherapy(NEMROCK 1999-2002).DiagnosisAcuostic neuromaLow grade gliomaHigh grade gliomaArteriovenous malformationMeningiomaMetastatic brain diseasePituitary adenomaOthersNumber10/2113/3914/204/229/293/50/84/19%433370203160021.1Table (10): Distribution of immediate side effects (I.S.E.)within different disease entities among 163patients treated by stereotactic radiosurgeryand radiotherapy (EMROCK 1999-2002).AcuosticNeuromaLow G.GliomaHigh G.GliomaAVMMeningiomaMetastasesOthersHeadache4553321Nausea &vomiting78101634Worsening ofpretreatmentdeficits0120200FitsTable (11): Incidence to develop nausea and vomitingaccording to radiation dose delivered to areapostrema among 163 patients treated by stereotacticradiosurgery and radiotherapy (NEM-ROCK 1999-2002).DoseN/VNoYeTotal0-≤ 2 Gy124613095.44.6100> 2 GyNo. % No. %0333301001000010010p-value< 0.0001Fig. (1): Cut section in human brain showing area postrema“vomiting center”.Vol. (%)100% = 0.49 cm 3 LesionNormal Tissue140Min. dose = 15.80 GyMax. dose = 20.00 Gy12010080604020Dose (%)00 20 40 60 80 100 120 140 160 180 200100% = 20.00 GyNo dose delivery for:Rt eye mri (12.64 cm 3 ) Lt eye mri (11.94 cm 3 )Fig. (2): Dose volume histogram showing adequate lesionvolume coverage without dose contribution tosurrounding normal structures and conformityindex approaching value 1.Vol. (%)100% = 28.20 cm 3 Brain Stem MRIMin. dose = 0.00 Gy140Max. dose = 7.50 Gy12010080604020Dose (%)00 20 40 60 80 100 120 140 160 180 200Fig. (3): Dose volume histogram of brain stem denotingsparing of the major part of its volume, keepingthe maximum dose (7.50 Gy) to less than 1% ofbrain stem volume. The treated lesion is locatedat the cerebello-pontine angle.
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