Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Herbert, Chris; Moiseenko, Vitali; McKenzie, Michael; Redekop, Gary; Hsu, Fred; Gete, E.; Gill, Beant S.; Lee, R.; Luchka, K.; Lee, A.; Haw, Charles S.; Toyota, Brian; Martin, Michel

doi:10.1017/s0317167100012415

Cited by 7 publications

(8 citation statements)

References 36 publications

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“…Publications indicate that AVM obliteration rates after a single procedure range from 70% to 80% over 5 years in selected groups, depending on AVM volume, dose delivered, location, and patient age. 1,5,6,8,13,19,25,29,33,35 The median time until MRI documentation of total obliteration of AVMs after Gamma Knife SRS (Elekta AB) has been shown to be 36 months. 16…”

mentioning

confidence: 99%

Hemorrhage during pregnancy in the latency interval after stereotactic radiosurgery for arteriovenous malformations

Tonetti¹,

Kano

Bowden

et al. 2014

JNS

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ObjectThe presentation for patients with arteriovenous malformations (AVMs) is often intracranial hemorrhage; for women, this frequently occurs during the prime childbearing years. Although previous studies have addressed the risk for AVM hemorrhage during pregnancy, such studies have not assessed the risk for hemorrhage among women who become pregnant during the latency interval between stereotactic radiosurgery (SRS) and documented obliteration of the lesion. The authors sought to evaluate the risk for hemorrhage in patients who become pregnant during the latency interval after SRS.MethodsThis single-institution retrospective analysis reviewed the authors' experience with Gamma Knife SRS during 1987–2012. During this time, 253 women of childbearing age (median age 30 years, range 15–40 years) underwent SRS for intracranial AVM. The median target volume was 3.9 cm3 (range 0.1–27.1 cm3), and the median marginal dose was 20 Gy (range 14–38 Gy). For all patients, the date of AVM obliteration was recorded and the latency interval was calculated. Information about subsequent pregnancies and/or bleeding events during the latency interval was retrieved from the medical records and supplemented by telephone contact.ResultsAVM obliteration was confirmed by MRI or angiography at a median follow-up time of 39.3 months (range 10–174 months). There were 828.7 patient-years of follow-up within the latency interval between SRS and the date of confirmed AVM obliteration. Among nonpregnant women, 20 hemorrhages occurred before AVM obliteration, yielding an annual hemorrhage rate of 2.5% for nonpregnant women during the latency interval. Among women who became pregnant during the latency interval, 2 hemorrhages occurred over the course of 18 pregnancies, yielding an annual hemorrhage rate of 11.1% for women who become pregnant during the latency interval. For the 2 pregnant patients who experienced hemorrhage, the bleeding occurred during the first trimester of pregnancy.ConclusionsThe authors present the first series of data for women with intracranial AVMs who became pregnant during the latency interval after SRS. Hemorrhage during the latency interval occurred at an annual rate of 2.5% for nonpregnant women and 11.1% for pregnant women. The data suggest that pregnancy might be a risk factor for AVM hemorrhage during the interval between SRS and AVM obliteration. However, this suggestion is not statistically significant because only 18 patients in the study population became pregnant during the latency interval. To mitigate any increased risk for hemorrhage, patients should consider deferring pregnancy until treatment conclusion and AVM obliteration.

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mentioning

confidence: 99%

Hemorrhage during pregnancy in the latency interval after stereotactic radiosurgery for arteriovenous malformations

Tonetti¹,

Kano

Bowden

et al. 2014

JNS

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“…In addition, some studies have reported on factors that affect complete obliteration after GKRS. Since AVM is a vascular disease, studies on hemodynamic factors, particularly angiographic features, have also been published [9,10,12]. Zipfel et al [13] reported that a diffuse type nidus was a risk factor for incomplete obliteration.…”

Section: Discussionmentioning

confidence: 99%

“…As research progressed, GKRS was established as an effective treatment modality for AVM [6][7][8]. Subsequent studies also reported on factors that contribute to favorable GKRS outcomes in AVM [9,10].…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up study of Gamma Knife radiosurgery for arteriovenous malformations with diffuse-type nidi

Chung

Park

Choi

et al. 2021

J Korean Ster Func Neurosurg

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Gamma Knife radiosurgery (GKRS) has been established as an effective treatment modality for arteriovenous malformations (AVMs). A study on the angiographic features of AVMs revealed that a diffuse-type nidus could impede complete obliteration after GKRS. In this study, we evaluated the long-term outcomes of GKRS for diffuse-type nidi and investigated other factors that could affect the prognosis.Methods: Among 598 patients who underwent GKRS for AVM at our institution, 75 patients who were diagnosed with diffuse-type nidi using angiographic imaging were followed. Postoperative outcomes were assessed using magnetic resonance imaging and digital subtraction angiography. Additionally, the patients' demographic characteristics, GKRS profiles, and relevant angiographic features were analyzed to determine other factors that could influence the prognosis.Results: Patients' mean age was 27.9±17.5 years (range: 4-70 years) and the mean follow-up period was 67.8±46.3 months (range: 12-206 months). Complete obliteration of the nidus was seen in 34 patients. Obliteration was observed, on average, 66 months after GKRS. Complications, including postprocedural bleeding and adverse radiation-induced changes, occurred in four patients. A high prescription dose (>23 Gy) was a significant factor for complete obliteration (p=0.032). Age, target volume, and the number of feeding vessels did not have statistically significant impacts on outcomes. Conclusion:The complete obliteration rate of GKRS for AVMs with diffuse-type nidi was 45%. The average time to complete obliteration was over 5 years. Long-term follow-up after GKRS with an appropriate dose is needed for patients with diffuse-type nidi.

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“…The importance of dose to the periphery of the AVM was demonstrated by Herbert et al who found that dose to the PTV margin >20Gy was strongly associated with nidus obliteration [14]. Because the incidence of symptomatic brain injury correlates with dose to surrounding NT, plan conformity is of the utmost importance.…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated stereotactic radiosurgery for arteriovenous malformations: guidance for treatment planning

et al. 2014

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BackgroundStereotactic Radiosurgery (SRS) is a common tool used to treat Arteriovenous Malformations (AVMs) in anatomical locations associated with a risk of surgical complications. Despite high rates of clinical effectiveness, SRS carries a risk of toxicity as a result of radiation injury to brain tissue. The use of intensity-modulated radiotherapy (IMRT) has increased because it may lead to improved PTV conformity and better Normal Tissue (NT) sparing compared to 3D Conformal Radiotherapy (3DCRT). The aim of this study was twofold: 1) to develop simple patient stratification rules for the recommendation of IMRT planning strategies over 3DCRT in the treatment of AVMs with SRS; and 2) to estimate the impact of IMRT in terms of toxicity reduction using retrospectively reported data for symptomatic radiation injury following SRS.MethodsThirty-one AVM patients previously treated with 3DCRT were replanned in a commercial treatment planning system using 3DCRT and static gantry IMRT with identical beam arrangements. The radiotherapy planning metrics analyzed included AVM volume, diameter, and volume to surface area ratio. The dosimetric endpoints analyzed included conformity index improvements and NT sparing measured by the maximum NT dose, and the volume of surrounding tissue that received 7Gy and 12Gy.ResultsOur analysis revealed stratified subsets of patients for IMRT that were associated with improved conformity, and those that were associated with decreased doses to normal tissue. The stratified patients experienced an improvement in conformity index by −6-68%, a reduction in the maximum NT dose by −0.5-12.3%, a reduction in the volume of NT receiving 7Gy by 1-8 cc, and a reduction in the volume of NT receiving 12Gy by 0–3.7 cc. The reduction in NT receiving 12Gy translated to a theoretical decrease in the probability of symptomatic injury by 0–9.3%.ConclusionsThis work indicates the potential for significant patient improvements when treating AVMs and provides rules to predict which patients are likely to benefit from IMRT.

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Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Cited by 7 publications

References 36 publications

Hemorrhage during pregnancy in the latency interval after stereotactic radiosurgery for arteriovenous malformations

Hemorrhage during pregnancy in the latency interval after stereotactic radiosurgery for arteriovenous malformations

Long-term follow-up study of Gamma Knife radiosurgery for arteriovenous malformations with diffuse-type nidi

Intensity-modulated stereotactic radiosurgery for arteriovenous malformations: guidance for treatment planning

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