title: Evaluation of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for cerebral cavernous malformations: a 15-year single-center experience.
abstract: OBJECTIVE
  Surgery is the principal treatment for safely accessible hemorrhagic and symptomatic cavernous malformations. Nevertheless, the role of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in the management of high-risk, symptomatic cavernoma lesions warrants further refinement. In this study, we evaluate the use of LINAC-based SRS for cerebral cavernous malformations (CMs) and report our 15-year single-center experience.
  
  
  METHODS
  A retrospective study from the Department of Radiation Oncology and the Department of Neurosurgery at Gulhane Military Medical Academy and Medical Faculty, Ankara from April 1998 to June 2013.
  
  
  METHODS
  Fifty-two patients (22 females and 30 males) with cerebral CM referred to our department underwent high-precision single-dose SRS using a LINAC with 6-MV photons. All patients had at least 1 bleeding episode prior to radiosurgery along with related symptoms. Median dose prescribed to the 85% to 95% isodose line encompassing the target volume was 15 Gy (range, 10-20).
  
  
  RESULTS
  Out of the total 52 patients, follow-up data were available for 47 patients (90.4%). Median age was 35 years (range, 19-63). Median follow-up time was 5.17 years (range, 0.08-9.5) after SRS. Three hemorrhages were identified in the post-SRS period. Statistically significant decrease was observed in the annual hemorrhage rate after radiosurgical treatment (pre-SRS 39% vs post-SRS 1.21, P < .0001). Overall, there were no radiosurgery-related complications resulting in mortality.
  
  
  CONCLUSIONS
  LINAC-based SRS may be considered as a treatment option for high-risk, symptomatic cerebral CM of selected patients with prior bleeding from lesions located at surgically inaccessible or eloquent brain areas.
authors.affiliation: Dr. Omer Sager, Department of Radiation Oncology,, Gulhane Military Medical Academy and Medical Faculty,, Ankara 06018, Turkey, T: +903123044683, F: +903123044680, omersager@gmail.com.
authors.forename: Omer
authors.initials: O
authors.lastname: Sager
authors.forename: Murat
authors.initials: M
authors.lastname: Beyzadeoglu
authors.forename: Ferrat
authors.initials: F
authors.lastname: Dincoglan
authors.forename: Bora
authors.initials: B
authors.lastname: Uysal
authors.forename: Hakan
authors.initials: H
authors.lastname: Gamsiz
authors.forename: Selcuk
authors.initials: S
authors.lastname: Demiral
authors.forename: Kaan
authors.initials: K
authors.lastname: Oysul
authors.forename: Bahar
authors.initials: B
authors.lastname: Dirican
authors.forename: Sait
authors.initials: S
authors.lastname: Sirin
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome