title: Linac stereotactic radiosurgery for the treatment of small arteriovenous malformations: lower doses can be equally effective.
abstract: OBJECTIVE
  The purpose of this study was to examine the efficacy and toxicity of treating small arteriovenous malformations (AVMs) (≤3 cm in diameter) with a median marginal applied dose of 14 Gy.
  
  
  METHODS
  Two hundred and thirteen patients diagnosed with AVMs were treated between January 1991 and December 2005. Seventy-three percent of the patients had hemorrhaged prior to treatment, 13% had had previous surgery and 19.2% had had previous embolization. The median follow-up duration was 48.1 months.
  
  
  RESULTS
  The Kaplan-Meier analysis estimated that the 36-month obliteration rate was 65.5% for patients undergoing their first stereotactic radiosurgery (SRS) and 68.3% for those undergoing repeated SRS. The Kaplan-Meier analysis estimated the 60-month AVMs obliteration rate for the entire cohort to be 82.4%. The median time to AVM obliteration was 40 ± 2.8 months. We found a statistically significant relationship between the time of obliteration and the following factors: site of the AVMs (sites other than brainstem), a higher prescribed dose and a positive history of previous hemorrhage. Thirteen patients (7.6%) experienced toxicities.
  
  
  CONCLUSIONS
  SRS was an effective and safe treatment for AVMs ≤3 cm in diameter, with acceptable toxicity.
authors: Radiotherapy Department, Instituto Madrileño de Oncologia/Grupo IMO, Madrid, Spain.
authors: G L
authors: GL
authors: Flores
authors: K
authors: K
authors: Sallabanda
authors: M A
authors: MA
authors: dos Santos
authors: J
authors: J
authors: Gutiérrez
authors: J C B P
authors: JC
authors: Salcedo
authors: C
authors: C
authors: Beltrán
authors: C P
authors: CP
authors: Fernández
authors: M G
authors: MG
authors: Atienza
authors: J
authors: J
authors: Samblás
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome