title: Volume-staged versus dose-staged stereotactic radiosurgery outcomes for large brain arteriovenous malformations: a systematic review.
abstract: OBJECTIVE Several recent studies have improved our understanding of the outcomes of volume-staged (VS) and dose-staged (DS) stereotactic radiosurgery (SRS) for the treatment of large (volume > 10 cm3) brain arteriovenous malformations (AVMs). In light of these recent additions to the literature, the aim of this systematic review is to provide an updated comparison of VS-SRS and DS-SRS for large AVMs. METHODS A systematic review of the literature was performed using PubMed to identify cohorts of 5 or more patients with large AVMs who had been treated with VS-SRS or DS-SRS. Baseline data and post-SRS outcomes were extracted for analysis. RESULTS A total of 11 VS-SRS and 10 DS-SRS studies comprising 299 and 219 eligible patients, respectively, were included for analysis. The mean obliteration rates for VS-SRS and DS-SRS were 41.2% (95% CI 31.4%-50.9%) and 32.3% (95% CI 15.9%-48.8%), respectively. Based on pooled individual patient data, the outcomes for patients treated with VS-SRS were obliteration in 40.3% (110/273), symptomatic radiation-induced changes (RICs) in 13.7% (44/322), post-SRS hemorrhage in 19.5% (50/256), and death in 7.4% (24/323); whereas the outcomes for patients treated with DS-SRS were obliteration in 32.7% (72/220), symptomatic RICs in 12.2% (31/254), post-SRS hemorrhage in 10.6% (30/282), and death in 4.6% (13/281). CONCLUSIONS Volume-staged SRS appears to afford higher obliteration rates than those achieved with DS-SRS, although with a less favorable complication profile. Therefore, VS-SRS or DS-SRS may be a reasonable treatment approach for large AVMs, either as stand-alone therapy or as a component of a multimodality management strategy.
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Adeel
authors.initials: A
authors.lastname: Ilyas
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Davis G
authors.initials: DG
authors.lastname: Taylor
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Shayan
authors.initials: S
authors.lastname: Moosa
authors.affiliation: 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Or
authors.initials: O
authors.lastname: Cohen-Inbar
authors.affiliation: 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D001164:Arteriovenous Fistula / Q000532:radiotherapy*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000532:radiotherapy*; D016634:Radiosurgery / Q000379:methods*
keywords: AVM = arteriovenous malformation; DS-SRS = dose-staged SRS; GK = Gamma Knife; Gamma Knife; LINAC = linear accelerator; RIC = radiation-induced change; SRS = stereotactic radiosurgery; SS-SRS = single-session SRS; VS-SRS = volume-staged SRS; arteriovenous malformation; dose-staged; radiosurgery; review; stereotactic radiosurgery; vascular disorders; volume-staged