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- W4200570400 abstract "Stereotactic radiosurgery (SRS) is a well-established treatment option that can obliterate cerebral arteriovenous malformations (AVMs). However, larger AVMs are more challenging to manage, with lower rates of obliteration and higher risk of complications. In this study, we report the obliteration rate and associated adverse effects of planned two-fraction proton SRS (PSRS) used to treat patients with larger AVMs that were deemed inoperable.A retrospective analysis including 75 patients with cerebral AVMs who received two-fraction PSRS at our institution between 1991 and 2019 was conducted. The median AVM nidus volume was 21.5 cc (range 1.4-58.1 cc). AVMs were located in critical/deep locations (basal ganglia, thalamus, or brainstem) in 21.3%. The median total dose for PSRS was 16 Gy(RBE) delivered in two fractions at a median of 7 days apart (range 1-82 days). Factors associated with obliteration and hemorrhage were assessed via univariable and multivariable analyses.Median follow up was 90 months (range 0.9-223.4 months). Total (8 patients, 11%) or partial (28 patients, 37%) obliteration was achieved among 48% of AVMs at a median time of 85.4 months (range 12.2-222.7 months). Five-year cumulative incidence of total obliteration was 29%. Five-year cumulative incidence of hemorrhage post-PSRS was 33%. Lesions with higher AVM scores were more likely to hemorrhage (P = 0.042). The most common adverse effect was Grade 1 headache acutely (11%) and long-term (9%). One patient developed a Grade 2 generalized seizure disorder.Planned two-fraction PSRS may be an effective and safe treatment option for achieving obliteration in patients with larger cerebral AVMs that are inoperable. Post-treatment hemorrhage remains a potential adverse event.D.W. Kim: None. G. Lee: None. P.H. Chapman: None. M.R. Bussiere: Consultant; American College of Radiology. J. Daartz: None. J.S. Loeffler: None. H.A. Shih: Employee; Dartmouth Hitchcock. Research Grant; AbbVie, NIH. Honoraria; UpToDate. Consultant; Cleveland Clinic. Speaker's Bureau; prIME Oncology. advisory; The Radiosurgery Society. director of clinical operations; Massachusetts General Hospital. clinical operational leader; Massachusetts General Hospital." @default.
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- W4200570400 date "2021-11-01" @default.
- W4200570400 modified "2023-10-14" @default.
- W4200570400 title "Two-Fraction Proton Beam Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations" @default.
- W4200570400 doi "https://doi.org/10.1016/j.ijrobp.2021.07.1615" @default.
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