title: Predictors for occlusion of cerebral AVMs following radiation therapy : Radiation dose and prior embolization, but not Spetzler-Martin grade.
abstract: BACKGROUND
  Intracranial arteriovenous malformations (AVMs) may show a harmful development. AVMs are treated by surgery, embolization, or radiation therapy.
  
  
  OBJECTIVE
  This study investigated obliteration rates and side effects in patients with AVMs treated by radiation therapy.
  
  
  METHODS
  A total of 40 cases treated between 2005 and 2013 were analyzed. Single-dose stereotactic radiosurgery (SRS) was received by 13 patients and 27 received hypofractionated stereotactic radiation therapy (HSRT). In 20 patients, endovascular embolization had been performed prior to irradiation and 24 patients (60 %) had a history of previous intracranial hemorrhage.
  
  
  RESULTS
  Treatment resulted in complete obliteration (CO) in 23/40 cases and partial obliteration in 8/40. CO was achieved in 85 % of patients receiving SRS compared to 44 % of those receiving HSRT. In the HSRT group, a first indication of an influence of AVM volume on obliteration rate was found. Equivalent 2 Gy fraction doses (EQD2) >70 Gy showed an obliteration rate of 50 %. Prior embolization was significantly associated with a higher portion of CO (p = 0.032). Median latency period (24.2 vs. 26 months) until CO was similar in both groups (SRS vs. HSRT). The rate of intracranial hemorrhage in patients with no prior bleeding events was 0 %.
  
  
  CONCLUSIONS
  Excellent obliteration rates were achieved by SRS. Consistent with the literature, this data analysis suggests that the results of HSRT are volume-dependent. Furthermore, regimens with EQD2 doses >70 Gy appear more likely to achieve obliteration than schemes with lower doses. The findings indicate that radiation therapy does not increase the risk of bleeding. Prior embolization may have a good prognostic impact.
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany. stefan.knippen@uk-erlangen.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Knippen
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Putz
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Semrau
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lambrecht
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
authors.forename: Arzu
authors.initials: A
authors.lastname: Knippen
authors.affiliation: Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Buchfelder
authors.affiliation: Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schlaffer
authors.affiliation: Department of Neuroradiology, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Struffert
authors.affiliation: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D000069473:Radiation Dose Hypofractionation; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Adverse effects; Angiography; Hemorrhage; Magnetic resonance imaging; Radiosurgery