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Title: Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem

Abstract

Purpose: To evaluate patient outcome and obliteration rates after radiosurgery (RS) for cerebral arteriovenous malformations (AVM) located deep, in the motor cortex or brainstem and those involving corpus callosum. Methods and Materials: This analysis is based on 65 patients. AVM classification according to Spetzler-Martin was 13 patients Grade 2, 39 Grade 3, 12 Grade 4, and 1 Grade 5. Median RS-based AVM score was 1.69. Median single dose was 18 Gy. Mean treatment volume was 5.2 cc (range, 0.2-26.5 cc). Forty patients (62%) experienced intracranial hemorrhage before RS. Median follow-up was 3.0 years. Results: Actuarial complete obliteration rate (CO) was 50% and 65% after 3 and 5 years, respectively. CO was significantly higher in AVM <3 cm (p < 0.02) and after doses >18 Gy (p < 0.009). Annual bleeding risk after RS was 4.7%, 3.4%, and 2.7% after 1, 2, and 3 years, respectively. AVM >3 cm (p < 0.01), AVM volume >4 cc (p < 0.009), and AVM score >1.5 (p < 0.02) showed a significant higher bleeding risk. Neurologic dysfunction improved, completely dissolved, or remained stable in 94% of patients. Conclusions: Surgically inaccessible AVM can be successfully treated using RS with acceptable obliteration rates and low riskmore » for late morbidity. The risk of intracranial hemorrhage is reduced after RS and depends on RS-based AVM score.« less

Authors:
 [1];  [2];  [3];  [4];  [2]
  1. Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany) and Department of RadioOncology, University of Heidelberg, Heidelberg (Germany). E-mail: A.Zabel@dkfz-heidelberg.de
  2. Department of RadioOncology, University of Heidelberg, Heidelberg (Germany)
  3. Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany)
  4. Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany)
Publication Date:
OSTI Identifier:
20793381
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.09.024; PII: S0360-3016(05)02715-X; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; HAZARDS; HEMORRHAGE; LINEAR ACCELERATORS; MALFORMATIONS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY

Citation Formats

Zabel-du Bois, Angelika, Milker-Zabel, Stefanie, Huber, Peter, Schlegel, Wolfgang, and Debus, Juergen. Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Zabel-du Bois, Angelika, Milker-Zabel, Stefanie, Huber, Peter, Schlegel, Wolfgang, & Debus, Juergen. Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem. United States. doi:10.1016/J.IJROBP.2005.0.
Zabel-du Bois, Angelika, Milker-Zabel, Stefanie, Huber, Peter, Schlegel, Wolfgang, and Debus, Juergen. Wed . "Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20793381,
title = {Stereotactic linac-based radiosurgery in the treatment of cerebral arteriovenous malformations located deep, involving corpus callosum, motor cortex, or brainstem},
author = {Zabel-du Bois, Angelika and Milker-Zabel, Stefanie and Huber, Peter and Schlegel, Wolfgang and Debus, Juergen},
abstractNote = {Purpose: To evaluate patient outcome and obliteration rates after radiosurgery (RS) for cerebral arteriovenous malformations (AVM) located deep, in the motor cortex or brainstem and those involving corpus callosum. Methods and Materials: This analysis is based on 65 patients. AVM classification according to Spetzler-Martin was 13 patients Grade 2, 39 Grade 3, 12 Grade 4, and 1 Grade 5. Median RS-based AVM score was 1.69. Median single dose was 18 Gy. Mean treatment volume was 5.2 cc (range, 0.2-26.5 cc). Forty patients (62%) experienced intracranial hemorrhage before RS. Median follow-up was 3.0 years. Results: Actuarial complete obliteration rate (CO) was 50% and 65% after 3 and 5 years, respectively. CO was significantly higher in AVM <3 cm (p < 0.02) and after doses >18 Gy (p < 0.009). Annual bleeding risk after RS was 4.7%, 3.4%, and 2.7% after 1, 2, and 3 years, respectively. AVM >3 cm (p < 0.01), AVM volume >4 cc (p < 0.009), and AVM score >1.5 (p < 0.02) showed a significant higher bleeding risk. Neurologic dysfunction improved, completely dissolved, or remained stable in 94% of patients. Conclusions: Surgically inaccessible AVM can be successfully treated using RS with acceptable obliteration rates and low risk for late morbidity. The risk of intracranial hemorrhage is reduced after RS and depends on RS-based AVM score.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 64,
place = {United States},
year = {Wed Mar 15 00:00:00 EST 2006},
month = {Wed Mar 15 00:00:00 EST 2006}
}