Image-Guided Stereotactic Radiosurgery Using Volumetric Modulated Arc Therapy for Arteriovenous Malformation of the Brain: Experiences of a Single Institution

Abstract

Purpose: To evaluate the therapeutic effects of brain arteriovenous malformation (AVM) treated with image-guided stereotactic radiosurgery using volumetric modulated arc therapy. Material and Methods: From March 2010 through November 2012, there were 20 patients with brain AVM treated with image-guided stereotactic radiosurgery in our institution. The median age at diagnosis was 40 years (ranged from 9 to 74 years). Fourteen patients were male (70%) and 6 were female (30%). Among all these 20 patients, 5 patients (25%) had previous surgery of craniotomy with excision, and 2 patients (10%) received previous endovascular embolization. No patients had been managed with observation only at the time of diagnosis. The median dose of stereotactic radiosurgery was 18 Gy (ranged from 12 to 20 Gy). The median clinical target volume was 3.6 c.c (ranged from 1.5 to 15.5 c.c). Results: The median follow-up period was 11.8 months (ranged from 4.7 to 35.4 months). Four patients (20%) had complete obliteration, 8 patients (40%) had partial obliteration, while 8 patients (40%) had stable diseases after treatments. The actuarial 1-year, 2-year and 3-year obliteration rates were 40%, 55% and 60%, respectively. Conclusion: The therapeutic effects of brain AVM treated with image-guided stereotactic radiosurgery using volumetric modulated arc therapy achieved 60% of both complete and partial obliteration rate within the median follow-up period of 11.8 months. The actuarial 1-year, 2-year and 3-year obliteration rates were 40%, 55% and 60%, respectively. The long-term follow-up duration should be warranted to evaluate the further treatment results.