Dose Hypofractionated Stereotactic Radiotherapy for Intracranial Arteriovenous Malformations: A Case Series and Review of the Literature.
Adult
Aged
Dose-Response Relationship, Radiation
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations
/ surgery
Male
Middle Aged
Postoperative Complications
/ epidemiology
Predictive Value of Tests
Radiation Dosage
Radiation Dose Hypofractionation
Radiosurgery
/ methods
Retrospective Studies
Treatment Outcome
Young Adult
Dose fractionation
Intracranial arteriovenous malformations
Radiosurgery
Radiotherapy dosage
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
16
10
2018
revised:
11
03
2019
accepted:
12
03
2019
pubmed:
25
3
2019
medline:
14
1
2020
entrez:
25
3
2019
Statut:
ppublish
Résumé
Brain arteriovenous malformations (AVMs) are pathologic tangles of intracerebral vessels. The treatment of AVMs aims to reduce the risk of devastating intracranial hemorrhage (ICH). Hypofractionated stereotactic radiotherapy (HSRT) can be used to treat large lesions and reduce the risk of radiation toxicity to the surrounding structures. We analyzed the data from our institutional experience of the past 15 years in treating large AVMs with both 5- and 6-fraction HSRT and evaluated the pretreatment characteristics that are most predictive of the radiographic response. We included 37 patients and 42 treatments of intracranial AVMs measuring >3 cm in their largest dimension. Data were collected retrospectively by reviewing the electronic health records. The AVM volume was measured before HSRT and at the most recent follow-up appointment. Symptomatic outcomes, including treatment-related inflammation, were measured and defined categorically. Complete obliteration was achieved in 11.9% of the patients. The mean AVM volume had decreased significantly after HSRT (P = 8.7e-8). The percentage of volume reduction differed significantly between patients receiving 30-Gy fractions, (∂V = -48.7%) and those receiving 25-Gy fractions (∂V = -29.1%; P = 0.035). Patients with partial or complete obliteration were more likely to have received a total dose of 30 Gy rather than 25 Gy (P = 0.056) and showed a trend toward being treatment naive (P = 0.053). HSRT can be used as a method to manage large AVMs, with obliteration in some cases and sufficient volume reduction in most others for adjuvant treatment with other modalities. The 30-Gy total dose was generally superior to 25 Gy in achieving obliteration or volume reduction. Further studies focused on longer follow-up periods are warranted.
Sections du résumé
BACKGROUND
BACKGROUND
Brain arteriovenous malformations (AVMs) are pathologic tangles of intracerebral vessels. The treatment of AVMs aims to reduce the risk of devastating intracranial hemorrhage (ICH). Hypofractionated stereotactic radiotherapy (HSRT) can be used to treat large lesions and reduce the risk of radiation toxicity to the surrounding structures. We analyzed the data from our institutional experience of the past 15 years in treating large AVMs with both 5- and 6-fraction HSRT and evaluated the pretreatment characteristics that are most predictive of the radiographic response.
METHODS
METHODS
We included 37 patients and 42 treatments of intracranial AVMs measuring >3 cm in their largest dimension. Data were collected retrospectively by reviewing the electronic health records. The AVM volume was measured before HSRT and at the most recent follow-up appointment. Symptomatic outcomes, including treatment-related inflammation, were measured and defined categorically.
RESULTS
RESULTS
Complete obliteration was achieved in 11.9% of the patients. The mean AVM volume had decreased significantly after HSRT (P = 8.7e-8). The percentage of volume reduction differed significantly between patients receiving 30-Gy fractions, (∂V = -48.7%) and those receiving 25-Gy fractions (∂V = -29.1%; P = 0.035). Patients with partial or complete obliteration were more likely to have received a total dose of 30 Gy rather than 25 Gy (P = 0.056) and showed a trend toward being treatment naive (P = 0.053).
CONCLUSION
CONCLUSIONS
HSRT can be used as a method to manage large AVMs, with obliteration in some cases and sufficient volume reduction in most others for adjuvant treatment with other modalities. The 30-Gy total dose was generally superior to 25 Gy in achieving obliteration or volume reduction. Further studies focused on longer follow-up periods are warranted.
Identifiants
pubmed: 30904809
pii: S1878-8750(19)30797-1
doi: 10.1016/j.wneu.2019.03.119
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1456-e1467Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.