Results of a Conservative Dose Plan Linear Accelerator-Based Stereotactic Radiosurgery for Pediatric Intracranial Arteriovenous Malformations.

Abstract

OBJECTIVE:

To evaluate the obliteration rate and clinical outcome following linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM) in pediatric patients (age ≤18 years).

METHODS:

Factors associated with the obliteration rate and neurologic complications were studied retrospectively in pediatric patients who underwent LINAC-based SRS for AVM between June 1995 and May 2014.

RESULTS:

The study cohort comprised 36 males and 33 females, with a median age at the time of SRS of 14 years (range, 7-18 years). The mean AVM volume was 8.5 ± 8.7 cc (range, 0.6-41.8 cc). The median marginal dose of radiation delivered was 15 Gy (range, 9-20 Gy). Magnetic resonance imaging (MRI) demonstrated complete obliteration of the AVM in 44 of the 69 patients (63.8%), at a mean follow up of 27.5 months (range, 12-90 months). On subgroup analysis, 41 of the 53 AVMs of ≤14 cc in volume (77.3%) were obliterated. AVMs with a modified AVM radiosurgery score <1 had significantly shorter obliteration times from the time of SRS (P = .006). On multivariate analysis, the mean marginal dose of radiation delivered to the AVM was the sole significant predictor of obliteration (odds ratio, 1.6; 95% confidence interval, 1 to 2.4).

CONCLUSIONS:

A modest median marginal dose of 15 Gy (16 Gy in the obliterated AVM group vs. 12 Gy in the nonobliterated group) resulted in an obliteration rate of 66.7% after LINAC-based SRS for intracranial AVM, with low rate.

• Authors: Vedantam Rajshekhar, Ranjith K Moorthy, Visalakshi Jeyaseelan, Subhashini John, Faith Rangad, P N Viswanathan, Paul Ravindran, Rabiraja Singh
• Journal: World neurosurgery (World Neurosurg) Vol. 95 Pg. 425-433 (Nov 2016) ISSN: 1878-8769 [Electronic] United States
• PMID: 27302562 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Angiography, Digital Subtraction
• Cerebral Angiography
• Child
• Cohort Studies
• Female
• Humans
• Intracranial Arteriovenous Malformations (diagnostic imaging, radiotherapy)
• Magnetic Resonance Imaging
• Male
• Particle Accelerators
• Radiosurgery (methods)
• Radiotherapy Dosage
• Retrospective Studies
• Treatment Outcome