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Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery

Published online by Cambridge University Press:  02 December 2014

C. Herbert ,
V. Moiseenko ,
M. McKenzie ,
G. Redekop ,
F. Hsu ,
E. Gete ,
B. Gill ,
R. Lee ,
K. Luchka  and
A. Lee
...Show all authors
C. Herbert*
Affiliation:
Department of Radiation Oncology, British Columbia Cancer Agency
V. Moiseenko
Affiliation:
Department of Medical Physics, British Columbia Cancer Agency
M. McKenzie
Affiliation:
Department of Radiation Oncology, British Columbia Cancer Agency
G. Redekop
Affiliation:
Division of Neurosurgery, Vancouver General Hospital, Vancouver
F. Hsu
Affiliation:
Department of Radiation Oncology, British Columbia Cancer Agency, Abbotsford, British Columbia, Canada
E. Gete
Affiliation:
Department of Medical Physics, British Columbia Cancer Agency
B. Gill
Affiliation:
Department of Medical Physics, British Columbia Cancer Agency
R. Lee
Affiliation:
Department of Medical Physics, British Columbia Cancer Agency
K. Luchka
Affiliation:
Department of Medical Physics, British Columbia Cancer Agency
A. Lee
Affiliation:
Department of Neurosurgery, Royal Columbian Hospital, New Westminster
C. Haw
Affiliation:
Department of Radiation Oncology, British Columbia Cancer Agency Division of Neurosurgery, Vancouver General Hospital, Vancouver
B. Toyota
Affiliation:
Division of Neurosurgery, Vancouver General Hospital, Vancouver
M. Martin
Affiliation:
Department of Medical Imaging, British Columbia Cancer Agency
*
Department of Radiation Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada.
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Abstract

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Objective:

To investigate predictive factors of complete obliteration following treatment with linac-based stereotactic radiosurgery for intracerebral arteriovenous malformations.

Methods:

Archived plans for 48 patients treated at the British Columbia Cancer Agency and who underwent post-treatment digital subtraction angiography to assess obliteration were studied. Actuarial estimates of obliteration were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of obliteration. Log-rank test was used to search for parameters associated with obliteration.

Results:

Complete nidus obliteration was achieved in 38/48 patients (79.2%). Actuarial rate of obliteration was 75.9% at 4 years (95% confidence interval 63.1%-88.6%). On univariate analysis, prescribed dose to the margin (p=0.002) and dose to isocentre (p=0.022) showed statistical significance. No parameters were significant in a multivariate model. According to the log-rank test, prescribed dose to the margin of >20 Gy (p=0.004) and dose to the isocentre of >25 Gy (p=0.004) were associated with obliteration.

Conclusion:

Reported series in the literature suggest a number of different factors are predictive of complete obliteration of arteriovenous malformations following radiosurgery. However, differing definitions of volume and complete obliteration makes direct comparison between series difficult. This study demonstrates that complete obliteration of the nidus following linear accelerator-based stereotactic radiosurgery for arteriovenous malformations appears to be most closely related to the prescribed marginal dose. In particular, a marginal dose of >20Gy is strongly associated with obtaining complete obliteration of the nidus.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 6 , November 2011 , pp. 845 - 850
Copyright
Copyright © The Canadian Journal of Neurological 2011

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