Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence

Levy, Richard P.; Fabrikant, Jacob I.; Frankel, Kenneth A.; Phillips, Mark H.; Lyman, J T

doi:10.1097/00006123-198906000-00009

Cited by 26 publications

(53 citation statements)

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“…Previous studies on intracranial AVMs have reported that the risk of hemorrhage during the latency period decrease [37][38], remains unchanged [36,39], or even increases [15,40] when compared with the natural course of the disease. Of note, these prior cerebral AVM studies tended to compare the risk of hemorrhage among selected patients who underwent radiosurgery with patients who did not undergo radiosurgery; in contrast, the present series analyzed changes in the rate of hemorrhage pre-and post-radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

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CyberKnife Ablation for Intramedullary Spinal Cord Arteriovenous Malformations (AVMs): A New Promising New Therapeutic Approach

Adler¹,

Gupta²,

Chang³

et al. 2010

Cureus

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Section: Discussionmentioning

confidence: 99%

“…The choice of dose in this series was an ad hoc decision, drawing from our extensive experience treating AVMs in the brainstem, deep nuclei (38), and extra/intramedullary spinal tumors [16]. Especially early on, a multi-session approach was used to mitigate some of the risk of radiation-induced myelopathy.…”

Section: Figure 6: Data Visualizationsmentioning

confidence: 99%

CyberKnife Ablation for Intramedullary Spinal Cord Arteriovenous Malformations (AVMs): A New Promising New Therapeutic Approach

Adler¹,

Gupta²,

Chang³

et al. 2010

Cureus

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“…Bragg Peak: Each charged-particle beam can be directed stereotactically te place uniquely shaped three-dimensienal high-dese regiens precisely within the brain by adjusting the range, by spreading the Bragg peak, by intreducing tissue-equivalent cempensaters, and by using an apprepriately-shaped aperture [11,17]. Several entry angles are chesen se that the high-dese regiens .of the individual beams intersect within the target velume.…”

mentioning

confidence: 99%

Heavy-Charged-Particle Radiosurgery of the Pituitary Gland: Clinical Results of 840 Patients

Levy

Fabrikant

Frankel

et al. 1991

Stereotact Funct Neurosurg

119

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Since 1954, 840 patients have been treated at Lawrence Berkeley Laboratory with stereotactic charged-particle radiosurgery of the pituitary gland. The initial 30 patients were treated with proton beams; the subsequent 810 patients were treated with helium ion beams. In the great majority of the 475 patients treated for pituitary tumors, marked and sustained biochemical and clinical improvement was observed. Variable degrees of hypopituitarism developed in about one-third of patients treated solely with radiosurgery. In the earlier years of the program, 365 patients underwent radiosurgery to treat selected systemic diseases by inducing hypopituitarism. Focal temporal lobe necrosis and cranial nerve injury occurred in about 1% of patients who were treated with doses less than 230 Gy.

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“…Since A VM obliteration occurred at the lower dose levels of each protocol group, we lowered the doses delivered incrementally. At present, we have found that the optimal dose inducing obliteration of the A VM with the lowest risk of neurological sequelae depends on a number of factors and appears to lie in the range of 15 to 25 GyE, using the helium-ion Bragg peak [5,6,9,10]. Dose selection depends on size, shape and location of the AVM within the brain and a number of other factors including the total volume of normal brain that must be traversed by the plateau portion of the charged-particle beams.…”

Section: Methodsmentioning

confidence: 98%

“…At the University of California at Berkeley -Lawrence Berkeley Laboratory (UCB-LBL) we have. developed stereotactic heavy-charged-particle Bragg peak radiosurgery for treatment of symptomatic surgicallyinaccessible intracranial arteriovenous malformations (AVMs) [1][2][3][4][5][6][7][8][9][10]. Narrow beams of accelerated helium ions are directed stereotactically to defined intracranial targets.…”

Section: Introductionmentioning

confidence: 99%

Heavy-Charged-Particle Radiosurgery for Intracranial Arteriovenous Malformations

Fabrikant

Levy²,

Steinberg³

et al. 1991

Stereotact Funct Neurosurg

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We have treated over 400 patients with symptomatic inoperable intracranial arteriovenous malformations (AVMs) with stereotactic heavy-charged-particle Bragg peak radiosurgery at the University of California at Berkeley in a collaborative program with Stanford University Medical Center and the University of California Medical Center, San Francisco. A long-term dose-searching clinical trial protocol has been developed and we have followed more than 250 patients for more than 2 years. Initially, radiation doses ranged from 45 to 35 GyE, and now doses of 25, 20, 15 and, under special circumstances, 10 GyE, depending on a number of factors, are being evaluated. The characteristics of charged-particle beams provide a relatively homogeneous dose distribution with the 90% isodose contour to the periphery of the lesion. When the entire arterial phase of the AVM core is included in the treatment field, the rates for complete obliteration 3 years after treatment are: 90–95% for volumes ≤4 cm³; 90–95% for volumes > 4 and ≤14 cm³; and 60–70% for volumes > 14 cm³. The total obliteration rate for all volumes up to 70 cm³ is approximately 80–85%. For complete radiation-induced obliteration there is a relationship of dose and volume primarily, and location secondarily. Results on relationships between dose, AVM obliteration, and complications and sequelae of the radiosurgical procedure are presented and discussed.

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Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence

Cited by 26 publications

References 0 publications

CyberKnife Ablation for Intramedullary Spinal Cord Arteriovenous Malformations (AVMs): A New Promising New Therapeutic Approach

CyberKnife Ablation for Intramedullary Spinal Cord Arteriovenous Malformations (AVMs): A New Promising New Therapeutic Approach

Heavy-Charged-Particle Radiosurgery of the Pituitary Gland: Clinical Results of 840 Patients

Heavy-Charged-Particle Radiosurgery for Intracranial Arteriovenous Malformations

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