Role of external beam radiotherapy for arteriovenous malformation of the pancreas.

Pancreatic arteriovenous malformation (PAVM) is rare and is mainly reported from Asian countries. We incidentally encountered an asymptomatic, early-stage PAVM in a patient who presented with portal venous distention, Child B liver cirrhosis, and hepatoma. The PAVM had multiple feeding arteries and drainage into the portal vein and varices. Because surgery was not indicated, after considering the risks and bene-fits the patient chose treatment with 40 Gy of conformal radiotherapy for 4 weeks. Computed tomography performed 6 months later revealed reduction in the size of the PAVM. Treatment had lasting effects for 18 months without significant toxicity. As observed in many reports of radiotherapy for various AVMs, the radiotherapy may stall self-augmenting growth of the AVM. Conventional fractionated radiotherapy of 40 Gy may be a useful choice for early-stage PAVM.