Stereotactic proton beam therapy for intracranial arteriovenous malformations

Date
2005
Authors
Vernimmen F.J.A.I.
Slabbert J.P.
Wilson J.A.
Fredericks S.
Melvill R.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Purpose: To investigate hypofractionated stereotactic proton therapy of predominantly large intracranial arteriovenous malformations (AVMs) by analyzing retrospectively the results from a cohort of patients. Methods and Materials: Since 1993, a total of 85 patients with vascular lesions have been treated. Of those, 64 patients fulfilled the criteria of having an arteriovenous malformation and sufficient follow-up. The AVMs were grouped by volume: <14 cc (26 patients) and <14 cc (38 patients). Treatment was delivered with a fixed horizontal 200 MeV proton beam under stereotactic conditions, using a stereophotogrammetric positioning system. The majority of patients were hypofractionated (2 or 3 fractions), and the proton doses are presented as single-fraction equivalent cobalt Gray equivalent doses (SFEcGyE). The overall mean minimum target volume dose was 17.37 SFEcGyE, ranging from 10.38-22.05 SFEcGyE. Results: Analysis by volume group showed obliteration in 67% for volumes <14 cc and 43% for volumes <14 cc. Grade IV acute complications were observed in 3% of patients. Transient delayed effects were seen in 15 patients (23%), becoming permanent in 3 patients. One patient also developed a cyst 8 years after therapy. Conclusions: Stereotactic proton beam therapy applied in a hypofractionated schedule allows for the safe treatment of large AVMs, with acceptable results. It is an alternative to other treatment strategies for large AVMs. AVMs are likely not static entities, but probably undergo vascular remodeling. Factors influencing angiogenesis could play a new role in a form of adjuvant therapy to improve on the radiosurgical results. © 2005 Elsevier Inc.
Description
Keywords
Diseases, Drug dosage, Patient monitoring, Photogrammetry, Proton beams, Intracranial arteriovenous malformations (AVM), Stereophotgrammetry, Stereotactic protn beam therpay, Vascular lesions, Patient treatment, cobalt, adolescent, adult, article, beam therapy, brain arteriovenous malformation, cranial nerve paralysis, cyst, epilepsy, epileptic state, female, follow up, human, major clinical study, male, nausea and vomiting, neurologic disease, priority journal, proton radiation, radiation dose fractionation, retrospective study, safety, school child, stereophotogrammetry, treatment outcome, Adolescent, Adult, Child, Dose Fractionation, Female, Humans, Intracranial Arteriovenous Malformations, Male, Middle Aged, Protons, Radiosurgery, Retrospective Studies
Citation
International Journal of Radiation Oncology Biology Physics
62
1