BACKGROUND: Stereotactic radiosurgery (SRS) is considered to be a relatively safe procedure in cerebral arteriovenous malformation management. There are very few reported cases of SRS-associated/induced malignancies. METHODS: We show the case of a 21-year-old female who presented with a 21-mm(3) ruptured AVM in the right mesial frontocallosal region. Embolization and/or radiosurgery was proposed. She preferred radiosurgery. The AVM was treated with CyberKnife(®) SRS. RESULTS: She presented behavior changes 6 years after SRS. MRI showed a right subcortical frontal lesion with increased perfusion, more consistent with high-grade glioma. The lesion's center was within the irradiated region of the previous SRS, having received an estimated radiation dose of 4 Gy. Pathological examination noted a hypercellular tumor showing astrocytic tumor cells with moderate pleomorphism in a fibrillary background, endothelial proliferation, and tumor necrosis surrounded by perinecrotic pseudopalisades. Numerous mitotic figures were seen. The appearances were those of glioblastoma, WHO grade IV, with neuronal differentiation. SRS-associated/-induced GBM after treatment of a large AM is exceptional. SRS-associated/-induced malignancies are mostly GBMs and occur on average after a latency of 9.4 years, within very low-dose peripheral regions as well as the full-dose regions; 33.3 % of patients were under 20 years at the time of SRS, and in 66 % the lesion treated was a vascular pathology. CONCLUSION: Although it is unlikely that the risk of radiation-induced cancer will change the current standard of practice, patients must be warned of this potential possibility before treatment.
BACKGROUND: Stereotactic radiosurgery (SRS) is considered to be a relatively safe procedure in cerebral arteriovenous malformation management. There are very few reported cases of SRS-associated/induced malignancies. METHODS: We show the case of a 21-year-old female who presented with a 21-mm(3) ruptured AVM in the right mesial frontocallosal region. Embolization and/or radiosurgery was proposed. She preferred radiosurgery. The AVM was treated with CyberKnife(®) SRS. RESULTS: She presented behavior changes 6 years after SRS. MRI showed a right subcortical frontal lesion with increased perfusion, more consistent with high-grade glioma. The lesion's center was within the irradiated region of the previous SRS, having received an estimated radiation dose of 4 Gy. Pathological examination noted a hypercellular tumor showing astrocytic tumor cells with moderate pleomorphism in a fibrillary background, endothelial proliferation, and tumor necrosis surrounded by perinecrotic pseudopalisades. Numerous mitotic figures were seen. The appearances were those of glioblastoma, WHO grade IV, with neuronal differentiation. SRS-associated/-induced GBM after treatment of a large AM is exceptional. SRS-associated/-induced malignancies are mostly GBMs and occur on average after a latency of 9.4 years, within very low-dose peripheral regions as well as the full-dose regions; 33.3 % of patients were under 20 years at the time of SRS, and in 66 % the lesion treated was a vascular pathology. CONCLUSION: Although it is unlikely that the risk of radiation-induced cancer will change the current standard of practice, patients must be warned of this potential possibility before treatment.
Authors: Jody Filippo Capitanio; Pietro Panni; Alberto Luigi Gallotti; Carmen Rosaria Gigliotti; Francesco Scomazzoni; Stefania Acerno; Antonella Del Vecchio; Pietro Mortini Journal: Childs Nerv Syst Date: 2018-11-24 Impact factor: 1.475
Authors: Laura-Nanna Lohkamp; Christian Strong; Rafael Rojas; Matthew Anderson; Yosef Laviv; Ekkehard M Kasper Journal: Surg Neurol Int Date: 2016-11-21