Multiple predictors for LR were identified on UVA including ECOG status, GPA, presence of extra-cranial metastases, tumor location, and GTV volume 14; however, only GTV volume 14 cc remained significant on MVA (Hazard Ratio [HR]: 5.22; 95% Confidence Interval [CI] 1.08C25.37, p = 0.012). Open in a separate window Fig. in AVM cohorts. Baseline characteristics were comparable, except for higher Graded Prognostic Analysis (3C4) in the rBM (ABT: 25.0% vs. non-ABT: 49.0%, p = 0.033) and median age in the AVM (ABT: 51.4 vs. non-ABT: 35.4, p 0.001) cohorts. In both populations, OS and intracranial efficacy (rBMlocal control; AVMobliteration rates) were statistically similar between the cohorts. ABT 7-Chlorokynurenic acid sodium salt was associated with lower 1-year SRN rates in both populations: rBM, 3.1 versus 25.3% (p = 0.003); AVM, 6.7 vs. 14.6% (p = 0.063). On multivariate analysis, ABT was a significant predictive factor for rBM (HR: 0.17; 95% CI 0.03C0.88, p = 0.035), but did not reach statistical significance for AVM (HR: 0.36; 95% CI 0.09C1.52, p = 0.165). ABT use appears to be associated with a reduced risk of SRN following SRS, without detriment to OS or intracranial efficacy. A prospective trial to validate these findings is warranted. angiotensin blockade therapy, renal cell carcinoma, gastrointestinal, brain metastases, eastern cooperative oncology group, recursive partitioning analysis, graded prognostic assessment, gray, clinical target volume, planning target volume, isodose line AVM Nineteen (16.2%) of the 117 patients undergoing SRS ablation for AVM met criteria for the ABT group. The patients had statistically similar baseline and dosimetric characteristics (Table 2) except for 1 factor, age: the ABT cohort was older than non-ABT cohort (51.5 vs. 38.4 years, p 0.001). Median imaging follow-up for the AVM patients was statistically similar for the ABT and non-ABT cohorts, 24.8 and 20.9 months, respectively. Table 2 Baseline AVM patient and lesion characteristics between ABT and non-ABT cohorts angiotensin blockade therapy, arteriovenous malformation, stereotactic radiosurgery, gray, gross target volume, isodose line Overall survival No OS difference was seen between ABT and non-ABT cohorts in either population (Fig. 1a, b). For rBM patients, median survival for the ABT cohort was 11.6 months and for the non-ABT cohort was 15.3 months. For AVM patients, median survival was not reached for both cohorts. ABT was not a significant factor on UVA or MVA in both populations. Open in a separate window Fig. 1 7-Chlorokynurenic acid sodium salt KaplanCMeir Curve comparing OS in angiotensin blockade therapy (ABT) and stereotactic radiosurgery (SRS) vs. SRS alone for patients with resected brain metastases (a) and AVM (b) Local intracranial efficacy Resected brain metastases There was no difference in the cumulative incidence of LR (Fig. 2a) for the ABT and non-ABT cohorts at 1 year (15.6 vs. 9.0%, p = 0.31). Median time to LR was 8.1 vs. 7.1 months between the two cohorts. ABT was not a significant predictor of LR on UVA or MVA. Multiple predictors for LR were identified on UVA including ECOG status, GPA, presence of extra-cranial metastases, tumor location, and GTV volume 14; however, only GTV volume 14 cc remained significant on MVA (Hazard Ratio [HR]: 5.22; 95% Confidence Interval [CI] 1.08C25.37, p = 0.012). Open in a separate window Fig. 2 Comparison of intracranial efficacy for patients treated with angiotensin blockade therapy (ABT) and stereotactic radiosurgery (SRS) to SRS alone. Competing risk model to evaluate local control is utilized for resected brain metastases patients (a); Kaplan Meier model to compare obliteration rates for AVM patients (b) is utilized AVM Figure 2b demonstrates that the probability of obliteration was similar between the ABT and non-ABT cohorts: 1-year C 10.8 versus 2.4%; 2-year C 25.7 versus 16.9%. ABT was not a significant predictor for obliteration on both UVA and MVA. Ruptured AVM lesion and GTV 4 were significant on UVA, but neither was significant on MVA. Radiation necrosis Resected brain metastases In the entire post-operative SRS cohort, 46 patients (41.4%) with 49 (33.5%) lesions developed radiographic evidence of RN. 1-year risk of RN was lower in the ABT cohort, 11.1 versus 21.6% (p = 0.067). Significant predictors for RN on UVA included lung histology,.Multiple predictors for LR were identified on UVA including ECOG status, GPA, presence of extra-cranial metastases, tumor location, and GTV volume 14; however, only GTV volume 14 cc remained significant on MVA (Hazard Ratio [HR]: 5.22; 95% Confidence Interval [CI] 1.08C25.37, p = 0.012). Open in a separate window Fig. 19 (16.2%) in AVM cohorts. Baseline characteristics were similar, except for higher Graded Prognostic Analysis (3C4) in the rBM (ABT: 25.0% vs. non-ABT: 49.0%, p = 0.033) and median age in the AVM (ABT: 51.4 vs. non-ABT: 35.4, p 0.001) cohorts. In both populations, OS and intracranial efficacy (rBMlocal control; AVMobliteration rates) were statistically similar between the cohorts. ABT was associated with lower 1-year SRN rates in both populations: rBM, 3.1 versus 25.3% (p = 0.003); AVM, 6.7 vs. 14.6% (p = 0.063). On multivariate analysis, ABT was a significant predictive factor for rBM (HR: 0.17; 95% CI 0.03C0.88, p = 0.035), but did not reach statistical significance for AVM (HR: 0.36; 95% CI 0.09C1.52, p = 0.165). ABT use appears to be associated with a reduced risk of SRN following SRS, without detriment to OS or intracranial efficacy. A prospective trial to validate these findings is warranted. angiotensin blockade therapy, renal cell carcinoma, gastrointestinal, brain metastases, eastern cooperative oncology group, recursive partitioning analysis, graded prognostic assessment, gray, clinical target volume, planning target volume, isodose line AVM Nineteen (16.2%) of the 117 patients undergoing SRS ablation for AVM met criteria for the ABT group. The patients had statistically similar baseline and dosimetric characteristics (Table 2) except for 1 factor, age: the ABT cohort was older than non-ABT cohort (51.5 vs. 38.4 years, p 0.001). Median imaging follow-up for the AVM patients was statistically similar for the ABT and non-ABT cohorts, 24.8 and 20.9 months, respectively. Table 2 Baseline AVM patient and lesion characteristics between ABT and non-ABT cohorts angiotensin blockade therapy, arteriovenous malformation, stereotactic radiosurgery, gray, gross target volume, isodose line Overall survival No OS difference was seen between ABT and non-ABT cohorts in either OPD2 population (Fig. 1a, b). For rBM patients, median survival for the ABT cohort was 11.6 months and for the non-ABT cohort was 15.3 months. For AVM patients, median survival was not reached for both cohorts. ABT was not a significant factor on UVA or MVA in both populations. Open in a separate window 7-Chlorokynurenic acid sodium salt Fig. 1 KaplanCMeir Curve comparing OS in angiotensin blockade therapy (ABT) and stereotactic radiosurgery (SRS) vs. SRS alone for patients with resected brain metastases (a) and AVM (b) Local intracranial efficacy Resected brain metastases There was no difference in the cumulative incidence of LR (Fig. 2a) for the ABT and non-ABT cohorts at 1 year (15.6 vs. 9.0%, p = 0.31). Median time to LR was 8.1 vs. 7.1 months between the two cohorts. ABT was not a significant predictor of LR on UVA or MVA. Multiple predictors for LR were identified on UVA including ECOG status, GPA, presence of extra-cranial metastases, tumor location, and GTV volume 14; however, only GTV volume 14 cc remained significant on MVA (Hazard Ratio [HR]: 5.22; 95% Confidence Interval [CI] 1.08C25.37, p = 0.012). Open in a separate window Fig. 2 Comparison of intracranial efficacy for patients treated with angiotensin blockade therapy (ABT) and stereotactic radiosurgery (SRS) to SRS alone. Competing risk model to evaluate local control is utilized for resected brain metastases patients (a); Kaplan Meier model to compare obliteration rates for AVM patients (b) is utilized AVM Figure 2b demonstrates that the probability of obliteration was similar between 7-Chlorokynurenic acid sodium salt the ABT and non-ABT cohorts: 1-year C 10.8 versus 2.4%; 2-year C 25.7 versus 16.9%. ABT was not a significant predictor for obliteration on both UVA and MVA. Ruptured AVM lesion and GTV 4 were significant on UVA, but neither was significant on MVA. Radiation necrosis Resected brain metastases In the entire post-operative SRS cohort, 46 patients (41.4%) with 49 (33.5%) lesions developed radiographic evidence of RN. 1-year risk of RN was lower in the ABT cohort, 11.1 versus 21.6% (p = 0.067). Significant predictors for RN on UVA included lung histology, active systemic disease, presence of extra-cranial metastases, 1 BM, resected lesion, prescription IDL 80, PTV margin, GTV volume, and conformality index. ABT use showed a trend towards significance on UVA (p = 0.053). On MVA, ABT use (HR: 0.45; 95% CI 0.21C0.95, p = 0.036) was a statistically significant predictor for lower risk of RN, while larger GTV volume (HR: 4.29; 95% CI 1.13C16.19, p = 0.032) predicted for higher risk of RN. Of the 46 patients, 29 (70.7%) were symptomatic:.
