Single-Fraction Proton Beam Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations

摘要: Purpose/Objective(s) To evaluate the obliteration rate and potential adverse effects of single-fraction proton beam stereotactic radiosurgery (PSRS) in patients with cerebral arteriovenous malformations (AVMs). Methods Materials From 1991 to 2010, 248 consecutive 254 AVMs received PSRS at our institution. The median AVM nidus volume was 3.5 cc (range, 0.1-28.1 cc), 23% were critical/deep locations (basal ganglia, thalamus, or brainstem), most common prescription dose 15 Gy(relative biological effectiveness [RBE]). Univariable multivariable analyses performed assess factors associated hemorrhage. Results At a follow-up time 35 months 6-198 months), 64.6% obliterated. total 31 months 6-127 months), 5-year 10-year cumulative incidence 70% 91%, respectively. On univariable analysis, smaller target (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.86-0.93, P =.001), higher maximum (HR 1.14, CI 1.05-1.23, =.002) obliteration. Deep/critical location also decreased likelihood 0.68, 0.47-0.98, =.04). critical (adjusted HR [AHR] 0.42, 0.27-0.65, =.02) remained Posttreatment hemorrhage occurred 13 cases (5-year 7%), all among less than obliteration, 3 these events fatal. complication seizure, controlled medications, both acutely (8%) long term (9.1%). Conclusions current series is largest modern for AVMs. can achieve high minimal morbidity. Post-treatment remains potentially fatal risk who have not yet responded treatment.