Preliminary evaluation of long-term outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations – when is the right time for re-irradiation?
Journal Title: Annales Academiae Medicae Silesiensis - Year 2014, Vol 68, Issue 5
Abstract
AIM The purpose of the study is to evaluate the results of stereotactic radiosurgery for cerebral arteriovenous malformations (AVMs) in patients followed-up for at least two years. MATERIAL AND METHODS From a group of 91 patients irradiated with single-fraction radiosurgery, a subset of 58 patients followed-up for at least two years was selected. The median follow-up was 5.7 years. There were 8 Spetzler-Martin grade I lesions, 26 grade II, 20 grade III, and 4 grade IV. In 27 (42.6%) embolization was performed before radiosurgery. In 31 (53.5%) at least one intracranial hemorrhage was diagnosed before the treatment, in 18 (31%) the presenting symptom was epilepsy, in 38 (66.6%) headaches, in 14 (24%) paresis, in 9 (15.5%) visual deficits and in 5 (8.6%) speech disturbances. The patients were irradiated with single doses of 5–20 Gy (mean and median dose 16 and 17.5 Gy, respectively). The treatment was performed with a linear accelerator equipped with a micromultileaf collimator. RESULTS The actuarial one-year obliteration rate was 11%, two-year – 38%, three-year 47%, four-year – 67%, and five- -year – 72%. The median time to obliteration was 3.17 years. In five patients obliteration occurred at least four years after the irradiation. Two patients from this group were qualified for repeat radiosurgery, both of them after 7 years from the initial treatment. In both cases the AVMs finally occluded. CONCLUSIONS Long-term follow-up is required in patients after stereotactic radiosurgery for cerebral AVMs because obliteration can occur after the postulated 2–3 year latency period. Repeat radiosurgery is an effective method of treatment but an optimal time for re-irradiation is not clearly defined.
Authors and Affiliations
Sławomir Blamek, Dawid Larysz, Stanisław Kwiek, Leszek Miszczyk
Keywords
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