Single-fraction proton beam stereotactic radiosurgery for cerebral arteriovenous malformations.

Abstract

PURPOSE/OBJECTIVE(S):

To evaluate the obliteration rate and potential adverse effects of single-fraction proton beam stereotactic radiosurgery (PSRS) in patients with cerebral arteriovenous malformations (AVMs).

METHODS AND MATERIALS:

From 1991 to 2010, 248 consecutive patients with 254 cerebral AVMs received single-fraction PSRS at our institution. The median AVM nidus volume was 3.5 cc (range, 0.1-28.1 cc), 23% of AVMs were in critical/deep locations (basal ganglia, thalamus, or brainstem), and the most common prescription dose was 15 Gy(relative biological effectiveness [RBE]). Univariable and multivariable analyses were performed to assess factors associated with obliteration and hemorrhage.

RESULTS:

At a median follow-up time of 35 months (range, 6-198 months), 64.6% of AVMs were obliterated. The median time to total obliteration was 31 months (range, 6-127 months), and the 5-year and 10-year cumulative incidence of total obliteration was 70% and 91%, respectively. On univariable analysis, smaller target volume (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.86-0.93, P<.0001), smaller treatment volume (HR 0.93, 95% CI 0.90-0.96, P<.0001), higher prescription dose (HR 1.16, 95% CI 1.07-1.26, P=.001), and higher maximum dose (HR 1.14, 95% CI 1.05-1.23, P=.002) were associated with total obliteration. Deep/critical location was also associated with decreased likelihood of obliteration (HR 0.68, 95% CI 0.47-0.98, P=.04). On multivariable analysis, critical location (adjusted HR [AHR] 0.42, 95% CI 0.27-0.65, P<.001) and smaller target volume (AHR 0.81, 95% CI 0.68-0.97, P=.02) remained associated with total obliteration. Posttreatment hemorrhage occurred in 13 cases (5-year cumulative incidence of 7%), all among patients with less than total obliteration, and 3 of these events were fatal. The most common complication was seizure, controlled with medications, both acutely (8%) and in the long term (9.1%).

CONCLUSIONS:

The current series is the largest modern series of PSRS for cerebral AVMs. PSRS can achieve a high obliteration rate with minimal morbidity. Post-treatment hemorrhage remains a potentially fatal risk among patients who have not yet responded to treatment.

• Authors: Jona A Hattangadi-Gluth, Paul H Chapman, Daniel Kim, Andrzej Niemierko, Marc R Bussière, Alison Stringham, Juliane Daartz, Christopher Ogilvy, Jay S Loeffler, Helen A Shih
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 89 Issue 2 Pg. 338-46 (Jun 01 2014) ISSN: 1879-355X [Electronic] United States
• PMID: 24726288 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Analysis of Variance
• Cerebral Hemorrhage (etiology, mortality)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Humans
• Intracranial Arteriovenous Malformations (complications, diagnostic imaging, surgery)
• Male
• Middle Aged
• Proton Therapy (adverse effects, methods)
• Radiography
• Radiosurgery (adverse effects, methods)
• Radiotherapy Dosage
• Relative Biological Effectiveness
• Retrospective Studies
• Seizures (etiology)
• Young Adult