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Angiotensin receptor blockade: a novel approach for symptomatic radiation necrosis after stereotactic radiosurgery

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Abstract

Preclinical evidence suggests angiotensin blockade therapy (ABT) decreases late radiation toxicities. This study aims to investigate the association between ABT and symptomatic radiation necrosis (SRN) following stereotactic radiosurgery (SRS). Resected brain metastases (rBM) and arteriovenous malformation (AVM) patients treated with SRS from 2002 to 2015 were identified. Patients in the ABT cohort were on therapy during SRS and at 1-month follow up. Kaplan Meier method and cumulative incidence model were used to analyze overall survival (OS) and intracranial outcomes. 228 consecutive patients were treated with SRS: 111 with rBM and 117 with AVM. Overall, 51 (22.4%) patients were in the ABT group: 32 (28.8%) in the rBM and 19 (16.2%) in AVM cohorts. Baseline characteristics were similar, except for higher Graded Prognostic Analysis (3–4) 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 (rBM—local control; AVM—obliteration 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 0.03–0.88, p = 0.035), but did not reach statistical significance for AVM (HR: 0.36; 95% CI 0.09–1.52, 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.

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Acknowledgements

Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiation Oncology, Rush University Medical Center, 500 South Paulina, Chicago, IL, 60612, USA

    Mudit Chowdhary, Hui-Kuo G. Shu, Walter J. Curran Jr. & Ian R. Crocker

  2. Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Mudit Chowdhary, Derick Okwan-Duodu, Robert H. Press, Jaymin Jhaveri, Zachary S. Buchwald, Jim Zhong & Ross A. Abrams

  3. Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Jeffrey M. Switchenko

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bhavana V. Chapman

  5. Department of Therapeutic Radiology and Smilow Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Ranjit S. Bindra, Joseph N. Contessa, Henry S. Park, James B. Yu, Roy H. Decker & Kirtesh R. Patel

  6. Department of Neurosurgery and Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Jeffrey J. Olson & Nelson M. Oyesiku

Authors
  1. Mudit Chowdhary
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  2. Derick Okwan-Duodu
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  3. Jeffrey M. Switchenko
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  7. Jim Zhong
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  9. Ranjit S. Bindra
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  10. Joseph N. Contessa
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  11. Henry S. Park
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  12. James B. Yu
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  13. Roy H. Decker
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  14. Jeffrey J. Olson
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  15. Nelson M. Oyesiku
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  16. Ross A. Abrams
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  17. Hui-Kuo G. Shu
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  18. Walter J. Curran Jr.
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  19. Ian R. Crocker
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  20. Kirtesh R. Patel
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Correspondence to Mudit Chowdhary or Kirtesh R. Patel.

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Chowdhary, M., Okwan-Duodu, D., Switchenko, J.M. et al. Angiotensin receptor blockade: a novel approach for symptomatic radiation necrosis after stereotactic radiosurgery. J Neurooncol 136, 289–298 (2018). https://doi.org/10.1007/s11060-017-2652-0

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  • DOI: https://doi.org/10.1007/s11060-017-2652-0

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