Long-term follow up data on difficult to treat intracranial arteriovenous malformations treated with the CyberKnife

Gupta, Raghav; Moore, Justin M.; Amorin, Alvaro; Appelboom, Geoff; Chaudhary, Navjot; Iyer, Aditya; Soltys, Scott G.; Gibbs, Iris C.; Chang, Steven D.

doi:10.1016/j.jocn.2018.10.109

Cited by 9 publications

(15 citation statements)

References 11 publications

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“…developed permanent symptoms such as hemiparesis, reduced consciousness, visual, and ocular motor deficits. The median target volume in this study was larger than the aforementioned trials at 3.6 cm 3 (0.1-26.3 cm 3 ) with a median margin dose was 20 Gy (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The adverse event rates were found to be 3.2%, 5.8%, 6.7%, and 7.5% at 1, 2, 3, and 5 years, respectively.…”

Section: Avm Closure Ratesmentioning

confidence: 55%

“…Factors that predicted an increase in adverse radiation events included higher margin radiation dose, larger AVM volume, and higher Spetzler-Martin grade, which were all factors found in the present study to be nominally but not significantly associated with increased risk of toxicity. Data regarding use of CyberKnife in the treatment of cerebral AVMs has thus far been very limited with only a single study exploring long-term outcomes in the literature (2,(12)(13)(14)(15). This analysis by Colombo et al described a cohort of 279 patients diagnosed with intracranial AVMs treated with CyberKnife (2).…”

Section: Avm Closure Ratesmentioning

confidence: 99%

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Arteriovenous Malformations Treated With Frameless Robotic Radiosurgery Using Non-Invasive Angiography: Long-Term Outcomes of a Single Center Pilot Study

et al. 2020

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ObjectiveCT-guided, frameless robotic radiosurgery is a novel radiotherapy technique for the treatment of intracranial arteriovenous malformations (AVMs) that serves as an alternative to traditional catheter-angiography targeted, frame-based methods.MethodsPatients diagnosed with AVMs who completed single fraction frameless robotic radiosurgery at Medstar Georgetown University Hospital between July 20, 2006 – March 11, 2013 were included in the present study. All patients received pre-treatment planning with CT angiogram (CTA) and MRI, and were treated using the CyberKnife radiosurgery platform. Patients were followed for at least four years or until radiographic obliteration of the AVM was observed.ResultsTwenty patients were included in the present study. The majority of patients were diagnosed with Spetzler Martin Grade II (35%) or III (35%) AVMs. The AVM median nidus diameter and nidal volume was 1.8 cm and 4.38 cc, respectively. Median stereotactic radiosurgery dose was 1,800 cGy. After a median follow-up of 42 months, the majority of patients (81.3%) had complete obliteration of their AVM. All patients who were treated to a total dose of 1800 cGy demonstrated complete obliteration. One patient treated at a dose of 2,200 cGy developed temporary treatment-related toxicity, and one patient developed post-treatment hemorrhage.ConclusionsFrameless robotic radiosurgery with non-invasive CTA and MRI radiography appears to be a safe and effective radiation modality and serves as a novel alternative to traditional invasive catheter-angiography, frame-based methods for the treatment of intracranial AVMs. Adequate obliteration can be achieved utilizing 1,800 cGy in a single fraction, and minimizes treatment-related side effects.

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Section: Avm Closure Ratesmentioning

confidence: 55%

Section: Avm Closure Ratesmentioning

confidence: 99%

Arteriovenous Malformations Treated With Frameless Robotic Radiosurgery Using Non-Invasive Angiography: Long-Term Outcomes of a Single Center Pilot Study

et al. 2020

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“…Most larger studies on SRS treatment of cerebral AVMs were carried out on Gamma Knife and LINAC systems, while the literature on AVM treatment by CyberKnife is sparse. We found three studies with rather small sample sizes of less than 30 patients that had obliteration rates between 66% and 78% (37)(38)(39). One larger study evaluating the three-year outcome of 102 patients treated with CyberKnife SRS (40) found an obliteration rate of 71.5%, which was higher than ours.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging-Based Robotic Radiosurgery of Arteriovenous Malformations

Greve

Ehret²,

Hofmann³

et al. 2021

Front. Oncol.

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ObjectiveCyberKnife offers CT- and MRI-based treatment planning without the need for stereotactically acquired DSA. The literature on CyberKnife treatment of cerebral AVMs is sparse. Here, a large series focusing on cerebral AVMs treated by the frameless CyberKnife stereotactic radiosurgery (SRS) system was analyzed.MethodsIn this retrospective study, patients with cerebral AVMs treated by CyberKnife SRS between 2005 and 2019 were included. Planning was MRI- and CT-based. Conventional DSA was not coregistered to the MRI and CT scans used for treatment planning and was only used as an adjunct. Obliteration dynamics and clinical outcome were analyzed.Results215 patients were included. 53.0% received SRS as first treatment; the rest underwent previous surgery, embolization, SRS, or a combination. Most AVMs were classified as Spetzler-Martin grade I to III (54.9%). Hemorrhage before treatment occurred in 46.0%. Patients suffered from headache (28.8%), and seizures (14.0%) in the majority of cases. The median SRS dose was 18 Gy and the median target volume was 2.4 cm³. New neurological deficits occurred in 5.1% after SRS, with all but one patient recovering. The yearly post-SRS hemorrhage incidence was 1.3%. In 152 patients who were followed-up for at least three years, 47.4% showed complete AVM obliteration within this period. Cox regression analysis revealed Spetzler-Martin grade (P = 0.006) to be the only independent predictor of complete obliteration.ConclusionsAlthough data on radiotherapy of AVMs is available, this is one of the largest series, focusing exclusively on CyberKnife treatment. Safety and efficacy compared favorably to frame-based systems. Non-invasive treatment planning, with a frameless SRS robotic system might provide higher patient comfort, a less invasive treatment option, and lower radiation exposure.

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“…Long-term follow-up of patients with AVMs is also an area without much published data. In 2019, both Gupta et al 26 and Hasegawa et al 27 published long-term follow-up data for AVMs treated with Cyberknife and Gamma Knife, respectively.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Intracranial Arteriovenous Malformation: Long-Term Outcomes with Linear Accelerator (LINAC)-Based Radiosurgery

Glazener

Lodin

Miller

et al. 2020

Advances in Radiation Oncology

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Purpose To analyze and report the long-term outcomes of intracranial arteriovenous malformations (AVM) treated with linear accelerator (LINAC)-based radiosurgery (LBRS) in the pediatric population. Methods and Materials A series of 34 pediatric patients (≤18 years old) who were treated between 2002 and 2016 were analyzed. All patients were treated with LBRS in a single fraction, with a median dose of 16.8 Gy to the 80% isodose line. Median age at treatment was 14.4 years (range 5.5-18.9). Median AVM volume was 2.91 mL (range 0.228-27.313). Median modified radiosurgery-based AVM score was 0.83 (range 0.18-2.96). The most common presenting symptom was intracranial hemorrhage (ICH) (n = 22, 64.7%). Nine patients underwent intervention before LBRS, which included prior embolization or resection. Seven lesions were in eloquent locations, defined as basal ganglia, thalamus, or brainstem. Cerebral angiography was done to confirm obliteration. Results Median follow-up time was 98 months (range 36-200 months). Twenty-two of the 34 lesions were obliterated (64.7%) with median time to obliteration of 37 months (range 14-79). No deaths occurred during the follow up period; however, two patients experienced ICH after treatment. Three other patients were treated for symptomatic radiation necrosis. Conclusions Treatment of intracranial AVM with LBRS in the pediatric population is demonstrated to be safe and effective with long-term follow up.

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Long-term follow up data on difficult to treat intracranial arteriovenous malformations treated with the CyberKnife

Cited by 9 publications

References 11 publications

Arteriovenous Malformations Treated With Frameless Robotic Radiosurgery Using Non-Invasive Angiography: Long-Term Outcomes of a Single Center Pilot Study

Arteriovenous Malformations Treated With Frameless Robotic Radiosurgery Using Non-Invasive Angiography: Long-Term Outcomes of a Single Center Pilot Study

Magnetic Resonance Imaging-Based Robotic Radiosurgery of Arteriovenous Malformations

Pediatric Intracranial Arteriovenous Malformation: Long-Term Outcomes with Linear Accelerator (LINAC)-Based Radiosurgery

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