The Risk of Radiation-induced Tumors or Malignant Transformation after Single-Fraction Intracranial Radiosurgery: Results Based on a 25-year Experience
Abstract Purpose To determine the risk of radiation-induced tumors or malignant transformation after single-fraction intracranial radiosurgery (SRS). Methods and Materials Retrospective review of 1,837 patients having single-fraction SRS for arteriovenous malformation (AVM) or benign tumor (meningio...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2017-04, Vol.97 (5), p.919-923 |
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| creator | Pollock, Bruce E., M.D Link, Michael J., M.D Stafford, Scott L., M.D Parney, Ian F., M.D., Ph.D Garces, Yolanda I., M.D Foote, Robert L., M.D |
| description | Abstract Purpose To determine the risk of radiation-induced tumors or malignant transformation after single-fraction intracranial radiosurgery (SRS). Methods and Materials Retrospective review of 1,837 patients having single-fraction SRS for arteriovenous malformation (AVM) or benign tumor (meningioma, vestibular schwannoma, pituitary adenoma, glomus tumor) at a single center between 1990 and 2009. Patients were excluded if they refused research authorization (n=31), had a genetic predisposition for tumor development (n=84), had prior or concurrent radiation therapy (n=79), or had less than 5 years of imaging follow-up after SRS (n=501). The median imaging follow-up of the remaining 1,142 patients was 9.0 years (range, 5-24.9). Results No radiation-induced tumors were identified in 11,264 patient-years of follow-up after SRS. The risk of developing a radiation-induced tumor after SRS was 0.0% at 5-years (95% CI 0.0%-0.4%), 0.0% at 10-years (95% CI 0.0%-0.9%), and 0.0% at 15-years (95% CI 0.0%-2.8%). Seven of 316 meningioma patients (2.2%) and 1 of 358 vestibular schwannoma patients (0.3%) had malignant transformation at a median of 4.9 years (range, 2.8-13.8) after SRS. No cases of malignant transformation were noted in patients with pituitary adenomas (n=188) or glomus tumors (n=47). The 5-year, 10-year, and 15-year risk of malignant transformation was 0.5% (95% CI 0.0%-0.9%), 0.8% (95% CI 0.0%-1.8%), and 2.4% (95% CI 0.0%-5.5%), respectively. Patients having prior resection (HR=14.56, 95% CI 1.79-118.33, P=0.01) and meningioma pathology (HR=11.72, 95% CI 1.44-96.15, P=0.02) were at increased risk of malignant transformation. Conclusions The risk of radiation-induced tumors or malignant transformation after SRS is very low and should not be used as a justification for choosing alternative treatment approaches (surgical resection, observation) over SRS for appropriate patients. |
| doi_str_mv | 10.1016/j.ijrobp.2017.01.004 |
| format | Article |
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Methods and Materials Retrospective review of 1,837 patients having single-fraction SRS for arteriovenous malformation (AVM) or benign tumor (meningioma, vestibular schwannoma, pituitary adenoma, glomus tumor) at a single center between 1990 and 2009. Patients were excluded if they refused research authorization (n=31), had a genetic predisposition for tumor development (n=84), had prior or concurrent radiation therapy (n=79), or had less than 5 years of imaging follow-up after SRS (n=501). The median imaging follow-up of the remaining 1,142 patients was 9.0 years (range, 5-24.9). Results No radiation-induced tumors were identified in 11,264 patient-years of follow-up after SRS. The risk of developing a radiation-induced tumor after SRS was 0.0% at 5-years (95% CI 0.0%-0.4%), 0.0% at 10-years (95% CI 0.0%-0.9%), and 0.0% at 15-years (95% CI 0.0%-2.8%). Seven of 316 meningioma patients (2.2%) and 1 of 358 vestibular schwannoma patients (0.3%) had malignant transformation at a median of 4.9 years (range, 2.8-13.8) after SRS. No cases of malignant transformation were noted in patients with pituitary adenomas (n=188) or glomus tumors (n=47). The 5-year, 10-year, and 15-year risk of malignant transformation was 0.5% (95% CI 0.0%-0.9%), 0.8% (95% CI 0.0%-1.8%), and 2.4% (95% CI 0.0%-5.5%), respectively. Patients having prior resection (HR=14.56, 95% CI 1.79-118.33, P=0.01) and meningioma pathology (HR=11.72, 95% CI 1.44-96.15, P=0.02) were at increased risk of malignant transformation. Conclusions The risk of radiation-induced tumors or malignant transformation after SRS is very low and should not be used as a justification for choosing alternative treatment approaches (surgical resection, observation) over SRS for appropriate patients.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2017.01.004</identifier><identifier>PMID: 28333013</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ADENOMAS ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; BIOMEDICAL RADIOGRAPHY ; Brain Neoplasms - epidemiology ; Brain Neoplasms - prevention & control ; Brain Neoplasms - therapy ; Cell Transformation, Neoplastic - radiation effects ; Child ; Child, Preschool ; Cranial Irradiation - statistics & numerical data ; Dose Fractionation ; Dose-Response Relationship, Radiation ; Female ; Hematology, Oncology and Palliative Medicine ; Humans ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Minnesota ; Neoplasms, Radiation-Induced - epidemiology ; PATIENTS ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - statistics & numerical data ; RADIOTHERAPY ; Risk Factors ; SURGERY ; Treatment Outcome ; Young Adult</subject><ispartof>International journal of radiation oncology, biology, physics, 2017-04, Vol.97 (5), p.919-923</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-c7c28738813b7ce0c1bcd199b95030e2634905563a5b2b2f44992f8f4fb3a80e3</citedby><cites>FETCH-LOGICAL-c511t-c7c28738813b7ce0c1bcd199b95030e2634905563a5b2b2f44992f8f4fb3a80e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2017.01.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28333013$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22649880$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Pollock, Bruce E., M.D</creatorcontrib><creatorcontrib>Link, Michael J., M.D</creatorcontrib><creatorcontrib>Stafford, Scott L., M.D</creatorcontrib><creatorcontrib>Parney, Ian F., M.D., Ph.D</creatorcontrib><creatorcontrib>Garces, Yolanda I., M.D</creatorcontrib><creatorcontrib>Foote, Robert L., M.D</creatorcontrib><title>The Risk of Radiation-induced Tumors or Malignant Transformation after Single-Fraction Intracranial Radiosurgery: Results Based on a 25-year Experience</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Abstract Purpose To determine the risk of radiation-induced tumors or malignant transformation after single-fraction intracranial radiosurgery (SRS). Methods and Materials Retrospective review of 1,837 patients having single-fraction SRS for arteriovenous malformation (AVM) or benign tumor (meningioma, vestibular schwannoma, pituitary adenoma, glomus tumor) at a single center between 1990 and 2009. Patients were excluded if they refused research authorization (n=31), had a genetic predisposition for tumor development (n=84), had prior or concurrent radiation therapy (n=79), or had less than 5 years of imaging follow-up after SRS (n=501). The median imaging follow-up of the remaining 1,142 patients was 9.0 years (range, 5-24.9). Results No radiation-induced tumors were identified in 11,264 patient-years of follow-up after SRS. The risk of developing a radiation-induced tumor after SRS was 0.0% at 5-years (95% CI 0.0%-0.4%), 0.0% at 10-years (95% CI 0.0%-0.9%), and 0.0% at 15-years (95% CI 0.0%-2.8%). Seven of 316 meningioma patients (2.2%) and 1 of 358 vestibular schwannoma patients (0.3%) had malignant transformation at a median of 4.9 years (range, 2.8-13.8) after SRS. No cases of malignant transformation were noted in patients with pituitary adenomas (n=188) or glomus tumors (n=47). The 5-year, 10-year, and 15-year risk of malignant transformation was 0.5% (95% CI 0.0%-0.9%), 0.8% (95% CI 0.0%-1.8%), and 2.4% (95% CI 0.0%-5.5%), respectively. Patients having prior resection (HR=14.56, 95% CI 1.79-118.33, P=0.01) and meningioma pathology (HR=11.72, 95% CI 1.44-96.15, P=0.02) were at increased risk of malignant transformation. Conclusions The risk of radiation-induced tumors or malignant transformation after SRS is very low and should not be used as a justification for choosing alternative treatment approaches (surgical resection, observation) over SRS for appropriate patients.</description><subject>ADENOMAS</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>BIOMEDICAL RADIOGRAPHY</subject><subject>Brain Neoplasms - epidemiology</subject><subject>Brain Neoplasms - prevention & control</subject><subject>Brain Neoplasms - therapy</subject><subject>Cell Transformation, Neoplastic - radiation effects</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cranial Irradiation - statistics & numerical data</subject><subject>Dose Fractionation</subject><subject>Dose-Response Relationship, Radiation</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Incidence</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minnesota</subject><subject>Neoplasms, Radiation-Induced - epidemiology</subject><subject>PATIENTS</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - statistics & numerical data</subject><subject>RADIOTHERAPY</subject><subject>Risk Factors</subject><subject>SURGERY</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEotvCP0DIEhcuCeOPfHFAgqqFSkVI20XiZjnOZOs0a2_tBHV_CX8XZ1M4cOFka_TMO6P3nSR5RSGjQIt3fWZ675p9xoCWGdAMQDxJVrQq65Tn-Y-nyQp4ASmP8ElyGkIPAJSW4nlywirOY52vkl-bWyRrE-6I68hatUaNxtnU2HbS2JLNtHM-EOfJVzWYrVV2JBuvbOic3x1RoroRPbkxdjtgeumVPlav7Bi_kTRqOOq6MPkt-sN7ssYwDWMgn1SIE2YFwvL0gMqTi4c9eoNW44vkWaeGgC8f37Pk--XF5vxLev3t89X5x-tU55SOqS41q0peVZQ3pUbQtNEtreumzoEDsoKLGvK84CpvWMM6IeqadVUnuoarCpCfJW8WXRdGI4M2I-pb7axFPUrGClFXFUTq7ULtvbufMIxyZ4LGYVAW3RQkjZAoAUoaUbGg2rsQPHZy781O-YOkIOfgZC-X4OQcnAQqY3Cx7fXjhKnZYfu36U9SEfiwABjd-GnQz8vOTrXGz7u2zvxvwr8CejDWaDXc4QFD7yZvo9OSysAkyJv5eObboSWPhyME_w2J18Dv</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Pollock, Bruce E., M.D</creator><creator>Link, Michael J., M.D</creator><creator>Stafford, Scott L., M.D</creator><creator>Parney, Ian F., M.D., Ph.D</creator><creator>Garces, Yolanda I., M.D</creator><creator>Foote, Robert L., M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20170401</creationdate><title>The Risk of Radiation-induced Tumors or Malignant Transformation after Single-Fraction Intracranial Radiosurgery: Results Based on a 25-year Experience</title><author>Pollock, Bruce E., M.D ; Link, Michael J., M.D ; Stafford, Scott L., M.D ; Parney, Ian F., M.D., Ph.D ; Garces, Yolanda I., M.D ; Foote, Robert L., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-c7c28738813b7ce0c1bcd199b95030e2634905563a5b2b2f44992f8f4fb3a80e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>ADENOMAS</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>BIOMEDICAL RADIOGRAPHY</topic><topic>Brain Neoplasms - epidemiology</topic><topic>Brain Neoplasms - prevention & control</topic><topic>Brain Neoplasms - therapy</topic><topic>Cell Transformation, Neoplastic - radiation effects</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cranial Irradiation - statistics & numerical data</topic><topic>Dose Fractionation</topic><topic>Dose-Response Relationship, Radiation</topic><topic>Female</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Incidence</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minnesota</topic><topic>Neoplasms, Radiation-Induced - epidemiology</topic><topic>PATIENTS</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - statistics & numerical data</topic><topic>RADIOTHERAPY</topic><topic>Risk Factors</topic><topic>SURGERY</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pollock, Bruce E., M.D</creatorcontrib><creatorcontrib>Link, Michael J., M.D</creatorcontrib><creatorcontrib>Stafford, Scott L., M.D</creatorcontrib><creatorcontrib>Parney, Ian F., M.D., Ph.D</creatorcontrib><creatorcontrib>Garces, Yolanda I., M.D</creatorcontrib><creatorcontrib>Foote, Robert L., M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pollock, Bruce E., M.D</au><au>Link, Michael J., M.D</au><au>Stafford, Scott L., M.D</au><au>Parney, Ian F., M.D., Ph.D</au><au>Garces, Yolanda I., M.D</au><au>Foote, Robert L., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Risk of Radiation-induced Tumors or Malignant Transformation after Single-Fraction Intracranial Radiosurgery: Results Based on a 25-year Experience</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>97</volume><issue>5</issue><spage>919</spage><epage>923</epage><pages>919-923</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Abstract Purpose To determine the risk of radiation-induced tumors or malignant transformation after single-fraction intracranial radiosurgery (SRS). Methods and Materials Retrospective review of 1,837 patients having single-fraction SRS for arteriovenous malformation (AVM) or benign tumor (meningioma, vestibular schwannoma, pituitary adenoma, glomus tumor) at a single center between 1990 and 2009. Patients were excluded if they refused research authorization (n=31), had a genetic predisposition for tumor development (n=84), had prior or concurrent radiation therapy (n=79), or had less than 5 years of imaging follow-up after SRS (n=501). The median imaging follow-up of the remaining 1,142 patients was 9.0 years (range, 5-24.9). Results No radiation-induced tumors were identified in 11,264 patient-years of follow-up after SRS. The risk of developing a radiation-induced tumor after SRS was 0.0% at 5-years (95% CI 0.0%-0.4%), 0.0% at 10-years (95% CI 0.0%-0.9%), and 0.0% at 15-years (95% CI 0.0%-2.8%). Seven of 316 meningioma patients (2.2%) and 1 of 358 vestibular schwannoma patients (0.3%) had malignant transformation at a median of 4.9 years (range, 2.8-13.8) after SRS. No cases of malignant transformation were noted in patients with pituitary adenomas (n=188) or glomus tumors (n=47). The 5-year, 10-year, and 15-year risk of malignant transformation was 0.5% (95% CI 0.0%-0.9%), 0.8% (95% CI 0.0%-1.8%), and 2.4% (95% CI 0.0%-5.5%), respectively. Patients having prior resection (HR=14.56, 95% CI 1.79-118.33, P=0.01) and meningioma pathology (HR=11.72, 95% CI 1.44-96.15, P=0.02) were at increased risk of malignant transformation. Conclusions The risk of radiation-induced tumors or malignant transformation after SRS is very low and should not be used as a justification for choosing alternative treatment approaches (surgical resection, observation) over SRS for appropriate patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28333013</pmid><doi>10.1016/j.ijrobp.2017.01.004</doi><tpages>5</tpages></addata></record> |
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| subjects | ADENOMAS Adolescent Adult Aged Aged, 80 and over BIOMEDICAL RADIOGRAPHY Brain Neoplasms - epidemiology Brain Neoplasms - prevention & control Brain Neoplasms - therapy Cell Transformation, Neoplastic - radiation effects Child Child, Preschool Cranial Irradiation - statistics & numerical data Dose Fractionation Dose-Response Relationship, Radiation Female Hematology, Oncology and Palliative Medicine Humans Incidence Longitudinal Studies Male Middle Aged Minnesota Neoplasms, Radiation-Induced - epidemiology PATIENTS Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - statistics & numerical data RADIOTHERAPY Risk Factors SURGERY Treatment Outcome Young Adult |
| title | The Risk of Radiation-induced Tumors or Malignant Transformation after Single-Fraction Intracranial Radiosurgery: Results Based on a 25-year Experience |
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