Five year results of linac radiosurgery for arteriovenous malformations: outcome for large AVMS
| Autor: | Grant B. Hieshima, Van V. Halbach, Michael C. Schell, Brian J. Goldsmith, David A. Larson, Vernon Smith, Keith A. Weaver, Philip H. Gutin, Bruce Lulu, Randall T. Higashida, Christopher F. Dowd, Lloyd Miyawaki, William M. Wara, Norman Albright, Lawrence H. Pitts, Charles B. Wilson |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male Cancer Research Adolescent medicine.medical_treatment Radiosurgery Necrosis Risk Factors medicine Humans Radiology Nuclear Medicine and imaging Child Radiation Injuries Aged Cerebral Hemorrhage Analysis of Variance Radiation business.industry Vascular disease Incidence (epidemiology) LINAC radiosurgery Brain Radiotherapy Dosage Arteriovenous malformation Middle Aged Prognosis medicine.disease Oncology Child Preschool Female Treatment factors Complication business Nuclear medicine Follow-Up Studies |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 44:1089-1106 |
| ISSN: | 0360-3016 1000-2200 |
| DOI: | 10.1016/s0360-3016(99)00102-9 |
| Popis: | For radiosurgery of large arteriovenous malformations (AVMs), the optimal relationship of dose and volume to obliteration, complications, and hemorrhage is not well defined. Multivariate analysis was performed to assess the relationship of multiple AVM and treatment factors to the outcome of AVMs significantly larger than previously reported in the literature.73 patients with intracranial AVMs underwent LINAC radiosurgery. Over 50% of the AVMs were larger than 3 cm in diameter and the median and mean treatment volumes were 8.4 cc and 15.3 cc, respectively (range 0.4-143.4 cc). Minimum AVM treatment doses varied between 1000-2200 cGy (median: 1600 cGy).The obliteration rates for treatment volumes4 cc, 4-13.9 cc, andor = 14 cc were 67%, 58%, and 23%, respectively. AVM obliteration was significantly associated with higher minimum treatment dose and negatively associated with a history of prior embolization with particulate materials. No AVM receiving1400 cGy was obliterated. The incidence of post-radiosurgical imaging abnormalities and clinical complications rose with increasing treatment volume. For treatment volumes14 cc receivingor = 1600 cGy, the incidence of post-radiosurgical MRI T2 abnormalities was 72% and the incidence of radiation necrosis requiring resection was 22%. The rate of post-radiosurgical hemorrhage was 2.7% per person-year for AVMs with treatment volumes14 cc and 7.5% per person-year for AVMsor = 14 cc.As AVM size increases, the dose-volume range for the optimal balance between successful obliteration and the risk of complications and post-radiosurgical hemorrhage narrows. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|