Abstract
Background and PurposeThe purpose of this study was to identify morphologic and dosimetric features associated with volume reduction velocity for arteriovenous malformation (AVM) after dose-stage stereotactic radiosurgery (DS-SRS).MethodsThirty patients with intracranial AVM were treated with DS fractionated SRS at Beijing Tiantan Hospital from 2011 to 2019. The AVM nidus was automatically segmented from DICOMRT files using the 3D Slicer software. The change in lesion volume was obtained from the decrease in the planning target volume (PTV) between the two treatment sessions. The volume reduction velocity was measured by the change in volume divided by the time interval between treatments. Fourteen morphologic features of AVM prior to treatment were extracted from the PTV using ‘Pyradiomics’ implemented in Python. Along with other dosimetric features, univariate and multivariate analyses were performed to explore predictors of the volume reduction velocity.ResultsAmong the 15 male (50.0%) and 15 female (50.0%) patients enrolled in this study, 17 patients (56.7%) initially presented with hemorrhage. The mean treatment interval between the initial and second SRS was 35.73 months. In multivariate analysis, the SurfaceVolumeRatio was the only independent factor associated with the volume reduction velocity (p=0.010, odds ratio=0.720, 95% confidence interval: 0.560–0.925). The area under the curve of this feature for predicting the volume reduction velocity after the initial treatment of DS-SRS was 0.83. (p=0.0018).ConclusionsThe morphologic features correlated well with the volume reduction velocity in patients with intracranial AVM who underwent DS-SRS treatment. The SurfaceVolumeRatio could predict the rate of volume reduction of AVMs after DS-SRS.
Highlights
Stereotactic radiosurgery (SRS) is gradually becoming a common therapeutic method for intracranial arteriovenous malformations (AVMs)
Thirty patients (15 males and 15 females) diagnosed with AVM and treated with DS-Fractionated stereotactic radiosurgery (FSRS) were enrolled in our study
The mean planning target volume (PTV) dose for the initial treatment was 19.72 Gy
Summary
Stereotactic radiosurgery (SRS) is gradually becoming a common therapeutic method for intracranial arteriovenous malformations (AVMs). Fractionated stereotactic radiosurgery (FSRS) can be used to avoid complications induced by a single high dose applied to all target lesions for large or high-grade AVMs. Volume-stage (VS) and dose-stage (DS) SRS are multi-session techniques aimed at improving the risk-to-benefit profile for radiotherapy of large AVMs [3,4,5,6]. The DS strategy was proposed for patients with AVM who have a large planning target volume (PTV); a relatively low dose was converged on the whole lesion for several repeats until the cumulative total dose was applied to the PTV. The VS strategy has been proposed for patients with multiple lesions or large volumes with a clear boundary in each encephalic region. The purpose of this study was to identify morphologic and dosimetric features associated with volume reduction velocity for arteriovenous malformation (AVM) after dose-stage stereotactic radiosurgery (DS-SRS)
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