부산대학교 도서관

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ijrobp.2005.09.021 Byline: Angelika Zabel-du Bois ([cor])(a ), Stefanie Milker-Zabel ([cor]), Peter Huber (a ), Wolfgang Schlegel (a ), Jurgen Debus ([cor]) Keywords: Radiotherapy; Radiosurgery; Hypofractionated; AVM; Obliteration rate Abstract: Purpose: We investigate retrospectively clinical outcome after radiosurgery (RS) or hypofractionated stereotactic radiotherapy (HSRT) in patients with large cerebral arteriovenous malformations (AVMs). Methods and Materials: This analysis is based on 48 patients with cerebral AVM greater than 4 cm treated with HSRT or RS at our institution. Fifteen patients received HSRT, with 26 Gy median total dose in 4 to 5 fractions, and 33 patients received RS with 17 Gy median total dose in 4 to 5 fractions. Median target volume was 27 cc in HSRT and 7 cc in RS; median maximum diameter was 6 cm and 5 cm, respectively. Seventeen patients experienced intracranial hemorrhage before treatment. Median follow-up was 2.6 years. Results: The 3-year and 4-year actuarial complete obliteration (CO) after HSRT was 17% and 33% and after RS was 47% and 60%, respectively. Actuarial CO was higher in AVMs less than 5 cm (66% vs. 37% after 4 years). Intracranial hemorrhage after HSRT occurred in 3 of 15 patients after 18 months median, and after RS in 7 of 33 patients after 17 months median. Bleeding risk was significantly higher in patients with prior hemorrhage (p < 0.04). Preexisting neurologic dysfunction improved/dissolved in 50% and remained stable in 45%. Conclusions: Large AVMs need a long time period to obliterate and show a high bleeding risk. Multimodal treatment strategies are required to reduce treatment volume before radiotherapy. Author Affiliation: ([cor]) Department of Radiooncology, University of Heidelberg, Heidelberg, Germany (a ) Department of Radiotherapy, German Cancer Research Center, Heidelberg, Germany (a ) Department of Medical Physics, German Cancer Research Center, Heidelberg, Germany Article History: Received 23 June 2005; Revised 26 August 2005; Accepted 26 September 2005