Stefan Knippen1, Florian Putz2, Sabine Semrau2, Ulrike Lambrecht2, Arzu Knippen2, Michael Buchfelder3, Sven Schlaffer3, Tobias Struffert4, Rainer Fietkau2. 1. Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany. stefan.knippen@uk-erlangen.de. 2. Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany. 3. Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. 4. Department of Neuroradiology, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
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 %. CONCLUSION: 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.
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 %. CONCLUSION: 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.
Entities:
Keywords:
Adverse effects; Angiography; Hemorrhage; Magnetic resonance imaging; Radiosurgery
Authors: Hideyuki Kano; L Dade Lunsford; John C Flickinger; Huai-che Yang; Thomas J Flannery; Nasir R Awan; Ajay Niranjan; Josef Novotny; Douglas Kondziolka Journal: J Neurosurg Date: 2011-11-11 Impact factor: 5.115
Authors: Yuri M Andrade-Souza; Meera Ramani; Daryl Scora; May N Tsao; Karel terBrugge; Michael L Schwartz Journal: Neurosurgery Date: 2007-03 Impact factor: 4.654
Authors: Furen Xiao; Alessandra A Gorgulho; Chun-Shu Lin; Chien-Hua Chen; Nzhde Agazaryan; Fernado Viñuela; Michael T Selch; Antonio A F De Salles Journal: Neurosurgery Date: 2010-11 Impact factor: 4.654
Authors: Hideyuki Kano; Douglas Kondziolka; John C Flickinger; Kyung-Jae Park; Aditya Iyer; Huai-che Yang; Xiaomin Liu; Edward A Monaco; Ajay Niranjan; L Dade Lunsford Journal: Prog Neurol Surg Date: 2012-12-11
Authors: Juha A Hernesniemi; Reza Dashti; Seppo Juvela; Kristjan Väärt; Mika Niemelä; Aki Laakso Journal: Neurosurgery Date: 2008-11 Impact factor: 4.654
Authors: J P Mohr; Michael K Parides; Christian Stapf; Ellen Moquete; Claudia S Moy; Jessica R Overbey; Rustam Al-Shahi Salman; Eric Vicaut; William L Young; Emmanuel Houdart; Charlotte Cordonnier; Marco A Stefani; Andreas Hartmann; Rüdiger von Kummer; Alessandra Biondi; Joachim Berkefeld; Catharina J M Klijn; Kirsty Harkness; Richard Libman; Xavier Barreau; Alan J Moskowitz Journal: Lancet Date: 2013-11-20 Impact factor: 79.321