title: Efficacy and morbidity of arc-therapy radiosurgery for cerebral arteriovenous malformations: a comparison with the natural history.
abstract: OBJECTIVE
  To report the results of arc-therapy radiosurgery for cerebral arteriovenous malformation (AVM) and to compare the adverse event rate with the rate expected from the natural history.
  
  
  METHODS
  We performed a retrospective study of our 118 first patients with a mean follow-up of 46 months (range, 5-105 months). The AVMs had features indicating a poor prognosis at initial presentation and had already been treated by previous embolizations in 88% of patients. The mean volume of the targets was 7.4 cm3 (range, 0.3-28.3 cm3). The mean minimal and maximal dose was 17.7 Gy (range, 10-25 Gy) and 24.5 Gy (range, 17-36 Gy), respectively.
  
  
  RESULTS
  The crude and 5-year actuarial rate of cure (total obstruction of the AVM shunt at angiography) was 54% (60 of 112) and 77%, respectively. The only independent prognostic factor of cure was the AVM volume (crude cure rate 67% for <7 cm3 vs. 35% for > or =7 cm3; p = 0.001). No patient died. Transient and permanent complications and hemorrhage occurred in 5%, 1.7%, and 6% of patients, respectively. The annual risk of an adverse event (hemorrhage or complication) was 3.9%.
  
  
  CONCLUSIONS
  The results of our series showed that radiosurgery, performed alone or after prior shrinkage of the AVM by embolization, is both effective and well tolerated, with a rate of adverse events comparable to that expected from the natural history.
authors.affiliation: Department of Radiotherapy, Centre Alexis Vautrin Cancer Center, Vandoeuvre-lès-Nancy, France. marc.bollet@curie.net
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bollet
authors.forename: René
authors.initials: R
authors.lastname: Anxionnat
authors.forename: Isabelle
authors.initials: I
authors.lastname: Buchheit
authors.forename: Pierre
authors.initials: P
authors.lastname: Bey
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cordebar
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jay
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Desandes
authors.forename: Christian
authors.initials: C
authors.lastname: Marchal
authors.forename: Michel
authors.initials: M
authors.lastname: Lapeyre
authors.forename: Pierre
authors.initials: P
authors.lastname: Aletti
authors.forename: Luc
authors.initials: L
authors.lastname: Picard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology*; D003221:Confusion / Q000209:etiology; D004621:Embolization, Therapeutic; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D016879:Salvage Therapy