title: Stereotactic multiple arc radiotherapy. I. Vascular malformations of the brain: an analysis of the first 108 patients.
abstract: Between March 1989 and December 1993, 101 patients with inoperable arteriovenous malformations (AVMs) and seven patients with inoperable angiographically occult malformations (AOVMs) have been treated with stereotactic multiple arc radiotherapy (SMART). All patients (excluding one patient with a brain stem AOVM) were treated with a uniform dose of 1750 cGy prescribed to the 90% isodose. Fifty-two patients with AVMs have had follow-up angiographic studies performed 11-42 months after SMART. The complete angiographic obliteration rates were 75-77% for AVMs < 10 cm3 and 40-75% for AVMs > 10 cm3, when studied 18-30 months after SMART. Four patients re-bled prior to complete obliteration representing an actuarial 2-year incidence of re-bleeding of 5.1%. Seven patients developed a new neurological deficit after SMART after a median latent interval of 17 months (range 6-32). The actuarial 2-year incidence of neurological complications was 1.8% for lesions < 10 cm3. The actuarial 2-year incidence of neurological complications was 16% for lesions > 10 cm3 (10.5% for persisting deficit). Of seven patients with AOVM six have shown a reduction in size and degree of contrast enhancement, but in no patient has there been complete resolution shown by CT. Five patients with AOVMs developed symptomatic neurological deterioration at a median of 6 months after SMART (range 5-9). When viewed in the context of the natural history of conservatively managed inoperable AVMs, this series has demonstrated that our highly specialized irradiation technique is a safe and effective treatment for many patients.
authors.affiliation: Radiotherapy Department, St Bartholomew's Hospital, London, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sebag-Montefiore
authors.forename: D
authors.initials: D
authors.lastname: Doughty
authors.forename: D
authors.initials: D
authors.lastname: Biggs
authors.forename: P N
authors.initials: PN
authors.lastname: Plowman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D016634:Radiosurgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome