title: Risk analysis of linear accelerator radiosurgery.
abstract: OBJECTIVE
  To evaluate the toxicity of stereotactic single-dose irradiation and to compare the own results with already existing risk prediction models.
  
  
  METHODS
  Computed tomography (CT) or magnetic-resonance (MR) images, and clinical data of 133 consecutive patients treated with linear accelerator radiosurgery were analyzed retrospectively. Using the Cox proportional hazards model the relevance of treatment parameters and dose-volume relationships on the occurrence of radiation-induced tissue changes (edema, localized blood-brain barrier breakdown) were assessed.
  
  
  RESULTS
  Sixty-two intraparenchymal lesions (arteriovenous malformation (AVM): 56 patients, meningioma: 6 patients) and 73 skull base tumors were selected for analysis. The median follow-up was 28.1 months (range: 9.0-58.9 months). Radiation-induced tissue changes (32 out of 135, 23.7%) were documented on CT or MR images 3.6-58.7 months after radiosurgery (median time: 17.8 months). The actuarial risk at 2 years for the development of neuroradiological changes was 25.8% for all evaluated patients, 38.4% for intraparenchymal lesions, and 14.6% for skull base tumors. The coefficient: total volume recieving a minimum dose of 10 Gy (VTREAT10) reached statistical significance in a Cox proportional hazards model calculated for all patients, intraparenchymal lesions, and AVMs. In skull base tumors, the volume of normal brain tissue covered by the 10 Gy isodose line (VBRAIN10) was the only significant variable.
  
  
  CONCLUSIONS
  These results demonstrate the particular vulnerability of normal brain tissue to single dose irradiation. Optimal conformation of the therapeutic isodose line to the 3D configuration of the target volume may help to reduce side effects.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, The University of Cologne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Voges
authors.forename: H
authors.initials: H
authors.lastname: Treuer
authors.forename: V
authors.initials: V
authors.lastname: Sturm
authors.forename: C
authors.initials: C
authors.lastname: Büchner
authors.forename: R
authors.initials: R
authors.lastname: Lehrke
authors.forename: M
authors.initials: M
authors.lastname: Kocher
authors.forename: S
authors.initials: S
authors.lastname: Staar
authors.forename: J
authors.initials: J
authors.lastname: Kuchta
authors.forename: R P
authors.initials: RP
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000528:radiation effects; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors