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• W2897054172 abstract "While fixed head-frame SRS is an established treatment strategy for AVM, the safety and efficacy of image-guided SRS with relocatable masks is less well-characterized. This study analyzes our long-term experience with IG-SRS in this disease, examining patient and treatment factors as regards outcome and describing serial MRI findings. In this institutional review board-approved retrospective study, we reviewed all charts of patients with brain AVM who underwent IG-SRS at our institution from March 1, 2008 - July 31, 2017. All patients were treated on a LINAC with a micro-multileaf collimator and orthogonal kV/cone-beam CT imaging using a relocatable face mask. PTV was the nidus volume contoured on T2-weighted MRI expanded 1mm. Patients typically received follow-up MRI’s measuring T2 and T1+C volume 6 months post-SRS and yearly, thereafter. Obliteration was determined via MRI or, preferably, angiography. Adverse events (AE) were determined using CTCAE v4.0. Survival curves were generated via the Kaplan-Meier method. In analyzing dose-volume effect, the LQ model with an α/β of 3 Gy was used to calculate biologically equivalent doses. A total of 72 patients with adequate information available for analysis were identified. Median patient age at SRS was 41yo (range 4-80) and 28 (38.9%) were female. Thirty-five (48.6%) patients had history of pre-SRS hemorrhage. 40 (55.6%) patients had undergone prior embolization, surgery, or SRS. Median pre-SRS KPS was 90 with 6 patients having KPS ≤60. 57 (79.2%) patients had AVMs in eloquent locations. Median nidal volume was 1.5 ml (range 0.1-36) and median prescribed marginal total dose was 1800 cGy (1200-3000). 57 (79.2%) patients underwent single-fraction SRS, 13 had 2-fraction SRS and 2 received five 6Gy fractions. The median volume of brain receiving 10 Gy was 15.7 ml (2.8-160), 12 Gy was 10.4 ml (2.1-115), and 15 Gy was 6.2 ml (0-85.5). Median follow-up was 47.9 mo (95% CI 37.6, 56.1). The median time to obliteration was 53.9 months (95% CI 46, 73.3); at 7 years post-SRS, the actuarial obliteration rate was 82.4% (95% CI 60.4, 96.1%.) Only 13 patients had severe (≥3) SRS-related AE; 4 Grade-3, 6 Grade-4, and 3 Grade-5. On univariate analysis, there was no significant association between grade ≥3 AE and irradiated volume, AVM volume or location eloquence. Post-SRS hemorrhage was observed in 6 (8.3%) patients. Overall survival was 91.2% 5 years post SRS, with 3 patients each dying from causes related vs. unrelated to AVM. Of 57 patients with >1 follow-up MRI, 37 (64.9%) saw an increase in T1+C volume with median time to peak volume of 11.1 mo (3.1-47.7); 47 (82.5%) patients showed an increase in T2 volume with median time to peak volume of 15.5 mo (2.7-78.3). IG-SRS appears to be a safe and efficacious method for treatment of brain AVMs. It is important to recognize that most patients experience post-SRS brain changes that seem to peak about one year following SRS. During this time of evolving brain response, patients require thorough and regular follow-up." @default.
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• W2897054172 date "2018-11-01" @default.
• W2897054172 modified "2023-09-27" @default.
• W2897054172 title "Long-term Outcomes and Imaging Response for Image-Guided Stereotactic Radiosurgery (IG-SRS) of Brain Arteriovenous Malformations (AVM)" @default.
• W2897054172 doi "https://doi.org/10.1016/j.ijrobp.2018.07.1090" @default.
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