title: Multimodality treatment for cerebral arteriovenous malformations: complementary role of proton beam radiotherapy.
abstract: A total of 29 cerebral arteriovenous malformations (AVMs) treated at the University of Tsukuba with multimodality treatment including proton beam (PB) radiotherapy for cerebral AVMs between 2005 and 2011 were retrospectively evaluated. Eleven AVMs were classified as Spetzler-Martin grades I and II, 10 as grade III, and 8 as grades IV and V. For AVMs smaller than 2.5 cm and located on superficial and non-eloquent areas, surgical removal with/without embolization was offered as a first-line treatment. For some small AVMs located in deep or eloquent lesions, gamma knife (GK) radiosurgery was offered. Some AVMs were treated with only embolization. AVMs larger than 2.5 cm were embolized to achieve reduction in size, to enhance the safety of the surgery, and to render the AVM amenable to GK radiosurgery. For larger AVMs located in deep or eloquent areas, PB radiotherapy was offered with/without embolization. Immediately after the treatment, 24 patients exhibited no neurological worsening. Four patients had moderate disability, and 1 patient had severe disability. Three patients suffered brain damage after surgical resection, and 2 patients suffered embolization complications. However, no neurological worsening was observed after either GK radiosurgery or PB radiotherapy, but 3 patients treated by PB radiotherapy suffered delayed hemorrhage. Fractionated PB radiotherapy for cerebral AVMs seems to be useful for the treatment of large AVMs, but careful long-term follow up is required to establish the efficacy and safety.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki. y-nakai@md.tsukuba.ac.jp
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Nakai
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sato
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nakamura
authors.forename: Masanari
authors.initials: M
authors.lastname: Shiigai
authors.forename: Tomoji
authors.initials: T
authors.lastname: Takigawa
authors.forename: Kensuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Go
authors.initials: G
authors.lastname: Ikeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ihara
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okumura
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000098:blood supply; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D061766:Proton Therapy; D016634:Radiosurgery; D012189:Retrospective Studies; D014041:Tokyo; D055815:Young Adult