ArticleFrontiers in neurology2025
Gamma knife radiosurgery for cerebral cavernous malformations: biologically effective dose predicts therapeutic outcomes.
Article in Frontiers in neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Gamma knife radiosurgery (GKRS) is an established option for cerebral cavernous malformations (CCMs) when microsurgical resection is not feasible. Lesion location strongly influences treatment strategy. The biologically effective dose (BED), introduced by J. F. Fowler, has been widely discussed in radiobiology but not evaluated in CCMs. Methods: A retrospective cohort study was conducted on 107 patients with 123 CCMs treated by GKRS at West China Hospital between June 2020 and December 2022. Post-GKRS hemorrhage was defined as symptomatic bleeding. The annual hemorrhage rate (AHR) quantified bleeding risk, and effective volumetric control was defined as ≥ 20% volume reduction. Clinical outcomes were categorized as improved, stable or worsened. Results: The mean age was 41 years, and 59.8% were female. Pre-GKRS hemorrhage was most frequent in brainstem (78.6%) and basal ganglia/thalamic lesions (73.3%). During follow-up, 13 patients (10.6%) experienced hemorrhage and AHR decreased from 13.6 to 4.3% per 100 lesion-years (IRR = 0.314; Conclusion: GKRS significantly reduced hemorrhage risk and promoted lesion regression in CCMs. BED was identified as a strong independent predictor of hemorrhage control, volume response and clinical outcomes, outperforming conventional dose metrics. These findings suggest that BED may guide personalized radiosurgical dose optimization for CCMs.
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