Hypofractionated stereotactic radiosurgery for treatment of cerebral arteriovenous malformations: outcome analysis with use of the modified arteriovenous malformation scoring system

Chen, Joseph C.T.; Mariscal, Luis; Girvigian, M.R.; Vanefsky, Marc A.; Glousman, Brandon N.; Miller, Michael J.; Feng, Lei; Rahimian, J.

doi:10.1016/j.jocn.2015.12.006

Cited by 23 publications

(10 citation statements)

References 59 publications

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“…This result is consistent with the conclusion of Chen et al. ( 6 ) They also found that the irradiated drainage vein volume indexed to AVM volume (volume of drainage vein involved in PTV/AVM volume) correlates well with the increased risks of post-SRS hemorrhage and reduced event-free survival. This result was consistent with the perception of our study that dose level was not a determinant of the volume reduction velocity after hypofractionated treatment, but rather the morphological characteristics of the lesion planned into the PTV.…”

Section: Discussionsupporting

confidence: 93%

“…Fractionated stereotactic radiosurgery (FSRS) can be used to avoid complications induced by a single high dose applied to all target lesions for large or high-grade AVMs. Volume-stage (VS) and dose-stage (DS) SRS are multi-session techniques aimed at improving the risk-to-benefit profile for radiotherapy of large AVMs ( 3 – 6 ). The DS strategy was proposed for patients with AVM who have a large planning target volume (PTV); a relatively low dose was converged on the whole lesion for several repeats until the cumulative total dose was applied to the PTV.…”

Section: Introductionmentioning

confidence: 99%

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Factors Affecting Volume Reduction Velocity for Arteriovenous Malformations After Treatment With Dose-Stage Stereotactic Radiosurgery

et al. 2021

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Background and PurposeThe purpose of this study was to identify morphologic and dosimetric features associated with volume reduction velocity for arteriovenous malformation (AVM) after dose-stage stereotactic radiosurgery (DS-SRS).MethodsThirty patients with intracranial AVM were treated with DS fractionated SRS at Beijing Tiantan Hospital from 2011 to 2019. The AVM nidus was automatically segmented from DICOMRT files using the 3D Slicer software. The change in lesion volume was obtained from the decrease in the planning target volume (PTV) between the two treatment sessions. The volume reduction velocity was measured by the change in volume divided by the time interval between treatments. Fourteen morphologic features of AVM prior to treatment were extracted from the PTV using ‘Pyradiomics’ implemented in Python. Along with other dosimetric features, univariate and multivariate analyses were performed to explore predictors of the volume reduction velocity.ResultsAmong the 15 male (50.0%) and 15 female (50.0%) patients enrolled in this study, 17 patients (56.7%) initially presented with hemorrhage. The mean treatment interval between the initial and second SRS was 35.73 months. In multivariate analysis, the SurfaceVolumeRatio was the only independent factor associated with the volume reduction velocity (p=0.010, odds ratio=0.720, 95% confidence interval: 0.560–0.925). The area under the curve of this feature for predicting the volume reduction velocity after the initial treatment of DS-SRS was 0.83. (p=0.0018).ConclusionsThe morphologic features correlated well with the volume reduction velocity in patients with intracranial AVM who underwent DS-SRS treatment. The SurfaceVolumeRatio could predict the rate of volume reduction of AVMs after DS-SRS.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Factors Affecting Volume Reduction Velocity for Arteriovenous Malformations After Treatment With Dose-Stage Stereotactic Radiosurgery

et al. 2021

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“…Thus, modern HfRT for large AVM delivers dose of over 4 Gy per fraction is recommended and proposed the fraction strategies are 7 Gy×4, 5.6 Gy×6, 4.7 Gy×8, and 4.2 Gy×10 which is the BED to a single-session radiosurgery 15 Gy [ 61 ]. In the previous report, the obliteration rates of HfRT were reported from 5% to 74% and the complication rate of HfRT rate were reported from 3% to 41% ( Table 2 ) [ 3 , 6 - 8 , 39 , 56 , 58 , 61 ].…”

Section: Radiosurgery For Large Cerebral Avmmentioning

confidence: 99%

Radiosurgery for Cerebral Arteriovenous Malformation (AVM) : Current Treatment Strategy and Radiosurgical Technique for Large Cerebral AVM

Byun

Kwon

Lee

et al. 2020

J Korean Neurosurg Soc

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Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system. AVM harbors 2.2% annual hemorrhage risk in unruptured cases and 4.5% annual hemorrhage risk of previously ruptured cases. Stereotactic radiosurgery (SRS) have been shown excellent treatment outcomes for patients with small-to moderated sized AVM which can be achieved in 80-90% complete obliteration rate with a 2-3 years latency period. The most important factors are associated with obliteration after SRS is the radiation dose to the AVM. In our institutional clinical practice, now 22 Gy (50% isodose line) dose of radiation has been used for treatment of cerebral AVM in single-session radiosurgery. However, dose-volume relationship can be unfavorable for large AVMs when treated in a single-session radiosurgery, resulting high complication rates for effective dose. Thus, various strategies should be considered to treat large AVM. The role of pre-SRS embolization is permanent volume reduction of the nidus and treat highrisk lesion such as AVM-related aneurysm and high-flow arteriovenous shunt. Various staging technique of radiosurgery including volume-staged radiosurgery, hypofractionated radiotherapy and dose-staged radiosurgery are possible option for large AVM. The incidence of post-radiosurgery complication is varied, the incidence rate of radiological post-radiosurgical complication has been reported 30-40% and symptomatic complication rate was reported from 8.1% to 11.8%. In the future, novel therapy which incorporate endovascular treatment using liquid embolic material and new radiosurgical technique such as gene or cytokinetargeted radio-sensitization should be needed.

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“…Similarly, given the infrequency with which grade I-II AVMs undergo SRS, insufficient data were available on less-common treatment considerations, such as hypofractionation. 61 …”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery for Spetzler-Martin Grade I and II Arteriovenous Malformations: International Society of Stereotactic Radiosurgery (ISRS) Practice Guideline

et al. 2020

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BACKGROUND No guidelines have been published regarding stereotactic radiosurgery (SRS) in the management of Spetzler-Martin grade I and II arteriovenous malformations (AVMs). OBJECTIVE To establish SRS practice guidelines for grade I-II AVMs on the basis of a systematic literature review. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant search of Medline, Embase, and Scopus, 1986-2018, for publications reporting post-SRS outcomes in ≥10 grade I-II AVMs with a follow-up of ≥24 mo. Primary endpoints were obliteration and hemorrhage; secondary outcomes included Spetzler-Martin parameters, dosimetric variables, and “excellent” outcomes (defined as total obliteration without new post-SRS deficit). RESULTS Of 447 abstracts screened, 8 were included (n = 1, level 2 evidence; n = 7, level 4 evidence), representing 1102 AVMs, of which 836 (76%) were grade II. Obliteration was achieved in 884 (80%) at a median of 37 mo; 66 hemorrhages (6%) occurred during a median follow-up of 68 mo. Total obliteration without hemorrhage was achieved in 78%. Of 836 grade II AVMs, Spetzler-Martin parameters were reported in 680: 377 were eloquent brain and 178 had deep venous drainage, totaling 555/680 (82%) high-risk SRS-treated grade II AVMs. CONCLUSION The literature regarding SRS for grade I-II AVM is low quality, limiting interpretation. Cautiously, we observed that SRS appears to be a safe, effective treatment for grade I-II AVM and may be considered a front-line treatment, particularly for lesions in deep or eloquent locations. Preceding publications may be influenced by selection bias, with favorable AVMs undergoing resection, whereas those at increased risk of complications and nonobliteration are disproportionately referred for SRS.

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Hypofractionated stereotactic radiosurgery for treatment of cerebral arteriovenous malformations: outcome analysis with use of the modified arteriovenous malformation scoring system

Cited by 23 publications

References 59 publications

Factors Affecting Volume Reduction Velocity for Arteriovenous Malformations After Treatment With Dose-Stage Stereotactic Radiosurgery

Factors Affecting Volume Reduction Velocity for Arteriovenous Malformations After Treatment With Dose-Stage Stereotactic Radiosurgery

Radiosurgery for Cerebral Arteriovenous Malformation (AVM) : Current Treatment Strategy and Radiosurgical Technique for Large Cerebral AVM

Stereotactic Radiosurgery for Spetzler-Martin Grade I and II Arteriovenous Malformations: International Society of Stereotactic Radiosurgery (ISRS) Practice Guideline

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