Results of a Conservative Dose Plan Linear Accelerator-Based Stereotactic Radiosurgery for Pediatric Intracranial Arteriovenous Malformations.
OBJECTIVE
To evaluate the obliteration rate and clinical outcome following linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM) in pediatric patients (age ≤18 years).


METHODS
Factors associated with the obliteration rate and neurologic complications were studied retrospectively in pediatric patients who underwent LINAC-based SRS for AVM between June 1995 and May 2014.


RESULTS
The study cohort comprised 36 males and 33 females, with a median age at the time of SRS of 14 years (range, 7-18 years). The mean AVM volume was 8.5 ± 8.7 cc (range, 0.6-41.8 cc). The median marginal dose of radiation delivered was 15 Gy (range, 9-20 Gy). Magnetic resonance imaging (MRI) demonstrated complete obliteration of the AVM in 44 of the 69 patients (63.8%), at a mean follow up of 27.5 months (range, 12-90 months). On subgroup analysis, 41 of the 53 AVMs of ≤14 cc in volume (77.3%) were obliterated. AVMs with a modified AVM radiosurgery score <1 had significantly shorter obliteration times from the time of SRS (P = .006). On multivariate analysis, the mean marginal dose of radiation delivered to the AVM was the sole significant predictor of obliteration (odds ratio, 1.6; 95% confidence interval, 1 to 2.4).


CONCLUSIONS
A modest median marginal dose of 15 Gy (16 Gy in the obliterated AVM group vs. 12 Gy in the nonobliterated group) resulted in an obliteration rate of 66.7% after LINAC-based SRS for intracranial AVM, with low rate.
Department of Neurological Sciences, Christian Medical College, Vellore 632004, Tamilnadu, India. Electronic address: rajshekhar@cmcvellore.ac.in.
Vedantam
V
Rajshekhar
Department of Neurological Sciences, Christian Medical College, Vellore 632004, Tamilnadu, India.
Ranjith K
RK
Moorthy
Department of Biostatistics, Christian Medical College, Vellore 632004, Tamilnadu, India.
Visalakshi
V
Jeyaseelan
Department of Radiotherapy, Christian Medical College, Vellore 632004, Tamilnadu, India.
Subhashini
S
John
Department of Radiotherapy, Christian Medical College, Vellore 632004, Tamilnadu, India.
Faith
F
Rangad
Department of Radiotherapy, Christian Medical College, Vellore 632004, Tamilnadu, India.
P N
PN
Viswanathan
Department of Radiotherapy, Christian Medical College, Vellore 632004, Tamilnadu, India.
Paul
P
Ravindran
Department of Radiotherapy, Christian Medical College, Vellore 632004, Tamilnadu, India.
Rabiraja
R
Singh
D000293:Adolescent; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D010315:Particle Accelerators; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
Arteriovenous malformation; Intracranial; Linear accelerator; Stereotactic radiosurgery