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Radiother Oncol. 2002 Jun;63(3):347-54.

An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration.

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  • 1Department of Radiation Oncology, Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, B-300, 200 Lothrop Street, Pittsburgh, PA 15213, USA.

Abstract

PURPOSE:

The aim of this study was to better understand arteriovenous malformation (AVM) obliteration rates after radiosurgery.

METHODS AND MATERIALS:

We studied obliteration after Gamma knife radiosurgery in 351 AVM patients with 3-11 years of follow-up imaging. The median marginal dose was 20 Gy (range: 12-30) and median treatment volume was 5.7 cm(3) (range: 0.26-24). Stereotactic targeting was with angiography alone in 250 AVMs, and additional magnetic resonance (MR) imaging in 101 AVMs.

RESULTS:

We documented obliteration by angiography in 193/264 (73%) AVM, and by MR alone in 75/87 (86%) AVM for a 75% corrected obliteration rate. We identified persistent out-of-field nidus in 18% of embolized vs. 5% of non-embolized patients, (P = 0.006). Multivariate analysis correlated in-field obliteration with marginal dose (P < 0.0001) and sex (P < or = 0.026, but not for overall obliteration P = 0.19). A mathematical dose-response model for overall obliteration was constructed to generate a dose-response curve for AVM obliteration with a maximum overall obliteration rate of 88% and minimal improvement above 25 Gy. We could not define the value of alpha/beta for AVM obliteration to a level of statistical significance.

CONCLUSION:

The rate of AVM obliteration from radiosurgery depends on the marginal dose administered with a dose-response curve that reaches a maximum of approximately 88%. The dose-response plateau reflects problems with target definition which is made more difficult by prior embolization.

Copyright 2002 Elsevier Science Ireland Ltd.

PMID:
12142099
[PubMed - indexed for MEDLINE]
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