Dynamic conformal arc radiosurgery for arteriovenous malformations: Outcome and influence of clinical and dosimetrical data

• Published in: Radiotherapy and oncology 2017-05, Vol.123 (2), p.251-256
• Main Authors: Clement-Colmou, Karen, Roualdes, Vincent, Martin, Stéphane-André, Josset, Stephanie, Desal, Hubert, Campion, Loïc, Thillays, François
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arteriovenous malformation; Child; Dynamic conformal arc radiotherapy; Female; Hematology, Oncology and Palliative Medicine; Humans; Intracranial Arteriovenous Malformations - radiotherapy; Linac; Male; Middle Aged; Novalis; Radiosurgery; Radiosurgery - methods; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated - methods; Retrospective Studies; Stereotactic radiotherapy; Treatment Outcome; Young Adult
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2017.03.013

Abstract Purpose To assess efficacy, toxicity, and their predictive factors for dynamic conformal arc arteriovenous malformations (AVM) stereotactic radiosurgery. Method Data concerning 90 consecutive patients were retrospectively studied. Clinical, radiological, dosimetrical data and quality indexes were computed. Results AVM median volume was 1.06 cc. Median prescribed dose was 22 Gy. Total occlusion was obtained for 69% of patients. Post-radiosurgery annual hemorrhage rate was 2.2%. Predictive factor for total occlusion was delivered dose. Undesirable events occurred for 28% of patients. Predictive factors for adverse events were AVM revealing mode with seizure or headache, age ≤ 28, AVM diameter ≥ 3 cm Spetzler–Martin score ≥ 4, V12 Gy ≥ 2 cc, large target volume and low homogeneity index ( p < 0.05). Brain parenchymal radiological reactions concerned 23% of patients, and their predictive factors were AVM revelation by seizure, deep localization, AVM diameter ≥ 3 cm, Spetzler–Martin score ≥ 4, previous radiosurgery, numerous embolization, target volume, V12 Gy and low homogeneity index ( p < 0.05). Conclusion Occlusion rate and toxicities are comparable to other series. Specific attention must be paid on pre-treatment clinical data, and target volume should be as small as possible, without reducing the delivered dose.