title: LINAC radiosurgery for cerebral arteriovenous malformations: a single centre prospective analysis and review of the literature.
abstract: Stereotactic radiosurgery (SRS) is a well established, minimally invasive treatment option for patients diagnosed with cerebral arteriovenous malformations (AVM). We present the experience in linear accelerator-based SRS for cerebral AVM treated over 14 years. We prospectively followed 67 patients with 69 AVM treated with SRS from 1994 to 2008, inclusive. The mean patient age was 37 years (range 7-69) with 36 women and 31 men. The median AVM size, as defined by maximal diameter, was 2.5 cm (range 0.5-4.6 cm) and the median marginal dose was 18 Gy in one fraction. The crude angiographic obliteration rate was 55% with a 3 and 5 year actuarial rate of 39% and 65%, respectively. Median time to obliteration was 4.2 years. Higher treatment dose (p<0.0001) and smaller maximal AVM diameter (p=0.002) were associated with an increased obliteration rate. There were no deaths from treatment. Post-treatment neurological complications occurred in 10 patients (15%) including hemorrhage in two. Twelve patients (18%) required a second SRS procedure. Larger AVM diameter was associated with increased odds of requiring re-treatment (p=0.02). Radiosurgery for intracerebral AVM is a non-invasive therapeutic option with low morbidity and a reasonable likelihood of nidus obliteration. Treatment dose and AVM diameter are the main determinants of obliteration.
authors.affiliation: Department of Neurosurgery, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia; Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia. Electronic address: andrew.zacest@health.sa.gov.au.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Zacest
authors.affiliation: Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Julianna
authors.initials: J
authors.lastname: Caon
authors.affiliation: Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Roos
authors.affiliation: Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Potter
authors.affiliation: Discipline of Public Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D019233:Retreatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteriovenous malformation; Linear accelerator; Obliteration; Stereotactic radiosurgery