title: Hypofractionated stereotactic radiotherapy in medium-sized to large arteriovenous malformations.
abstract: We have reviewed treatment results in terms of obliteration and complications in 24 patients with medium to large sized cerebral arteriovenous malformations (AVMs) (mean volume 18.5±8.9cm(3); range: 10-42) treated with hypofractionated stereotactic radiotherapy (HSRT). AVMs are congenital lesions associated with a high morbidity and mortality. Radiosurgery is one option for treatment. However, in larger AVMs with volumes exceeding 10cm(3) obliteration rates are less favourable and radiation induced complications more frequent. For larger AVMs, volume-staged radiosurgery is one option while another option may be the use of HSRT. Patients were treated with 6-7Gy in five fractions to a total dose of 30-35Gy (mean total dose 32.9±1.6Gy [standard error of the mean]). Sixteen patients (69.6%) showed obliteration after a mean time of 35.2±14.8 months (range: 24-60). Only one patient (4.2%) experienced symptomatic radionecrosis. Our treatment with HSRT seems safe and efficient for treatment of medium to large sized AVMs. Treatment results seem to be in line with volume-staged radiosurgery and may be an alternative for AVMs not suitable for single fraction radiosurgery.
authors.affiliation: Department of Clinical Neuroscience, Neurosurgery, Umeå University, 901 85 Umeå, Sweden. Electronic address: peter_lindvall_nkk@hotmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Lindvall
authors.affiliation: Department of Clinical Neuroscience, Neurosurgery, Umeå University, 901 85 Umeå, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Grayson
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Bergström
authors.affiliation: Department of Clinical Neuroscience, Neurosurgery, Umeå University, 901 85 Umeå, Sweden.
authors.forename: A Tommy
authors.initials: AT
authors.lastname: Bergenheim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000069473:Radiation Dose Hypofractionation; D011832:Radiation Injuries / Q000517:prevention & control; D016634:Radiosurgery / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteriovenous malformations; Linear accelerator; Radiosurgery; Treatment results