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Radiosurgery for Brain AVMs: Outcome analysis after 5 years

António Gonçalves Ferreira, Ana Raquel Escolastico, Herculano Carvalho, Rosário Vicente

 

Stereotactic Radiosurgery (SRS) has an important role in the treatment of AVMs. The aim of this study was to review the outcome of patients treated to brain AVMs in our center by SRS, taking into account: 1) the percentage of complete obliteration after 2, 3, 4 and ≥ 5 years in relation to the radiation dose, AVM localization and volume; 2) the morbidity related to the normal tissue receiving 12Gy.

A retrospective review of 100 patients treated between 2004 and 2012 was performed.

 

To delineate the target volume and the organs at risk, all patients had fusion of images between Angio-TC, Angio-MRI and a digital stereotactic angiography (DSA), the last two performed on the day of the treatment.


The patients age ranged from 20 to 60 years old and were irradiated with a single dose fraction from 14-17Gy, using 6MV photon beam. The treatments were undertaken in Linear Accelerator 2300CD_Trilogy® (Varian Medical Systems, Inc., Palo Alto, CA), with the HD120 Micromultileaf incorporated, at Centro Oncológico Drª Natália Chaves, Carnaxide.


To assess the outcome, only patients with a minimum of 2 years of follow-up were included. Complete obliteration was always confirmed by DSA.

 


Therapeutical Results:

 

63.7% of the patients had an excellent result with the complete obliteration of the AVM, 42.9% without any complication, and 30.8% of the patients have a major reduction of the nidus.

 

55.5% of the patients showed complete obliteration after 2 years of follow-up, 10.3% more patients were cured after 3 years plus 6.9% and 8.6% after 4 years and 5 years respectively. The mean time to achieve complete obliteration was of 2.4 years.


The main temporary and permanent neurological sequelae are dose related to normal tissue irradiated, namely dose above 12Gy. The deficits found are dependent not only on the volume of the lesion, but also on the deep location of the irradiated brain.

 


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