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Clinical and radiological response of aggressive dural arteriovenous fistula after combined glue embolization and hypofractionated helical TomoTherapy

Published online by Cambridge University Press:  23 April 2021

Withawat Vuthiwong Open the ORCID record for Withawat Vuthiwong [Opens in a new window] ,
Anirut Watcharawipha ,
Bongkot Jia- Mahasap ,
Wannapha Nobnop  and
Imjai Chitapanarux Open the ORCID record for Imjai Chitapanarux [Opens in a new window]
Withawat Vuthiwong
Affiliation:
Department of Diagnostic Radiology and Interventional Neuroradiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Anirut Watcharawipha
Affiliation:
Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Bongkot Jia- Mahasap
Affiliation:
Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wannapha Nobnop
Affiliation:
Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Imjai Chitapanarux*
Affiliation:
Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*
Author for correspondence: Imjai Chitapanarux, M.D., Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 110 Intawarorose Road, Chiang Mai, 50200, Thailand. Tel: +66-53-935456; Fax: +66-53-935491. E-mail: imjai@hotmail.com; imjai.chitapanarux@cmu.acth
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Abstract

Purpose:

We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).

Materials and methods:

Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.

Results:

There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the Reff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI50 were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The Reff,Rx and Reff,50%Rx were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The Reff between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).

Conclusions:

Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.

Keywords

dural arteriovenous fistulaglue embolizationhypofractionation helical TomoTherapyinter-cranial vascular malformations
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 4 , December 2022 , pp. 513 - 518
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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