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Radiosurgical Retreatment for Brain Arteriovenous Malformation

Published online by Cambridge University Press:  02 December 2014

Javad Mirza-Aghazadeh ,
Yuri M. Andrade-Souza ,
Gelareh Zadeh ,
Daryl Scora ,
May N. Tsao  and
Michael L. Schwartz
Javad Mirza-Aghazadeh
Affiliation:
Division of Neurosurgery, Sunnybrook and Women's College Health Science Centre, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Ontario, Canada
Yuri M. Andrade-Souza
Affiliation:
Division of Neurosurgery, Sunnybrook and Women's College Health Science Centre, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Ontario, Canada
Gelareh Zadeh
Affiliation:
Division of Neurosurgery, Sunnybrook and Women's College Health Science Centre, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Ontario, Canada
Daryl Scora
Affiliation:
Division of Neurosurgery, Sunnybrook and Women's College Health Science Centre, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Ontario, Canada
May N. Tsao
Affiliation:
Division of Neurosurgery, Sunnybrook and Women's College Health Science Centre, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Ontario, Canada
Michael L. Schwartz*
Affiliation:
Division of Neurosurgery, Sunnybrook and Women's College Health Science Centre, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Ontario, Canada
*
Division of Neurosurgery, Suite A129, Sunnybrook Health Science Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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Abstract:

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Objective:

To analyze our experience with a second radiosurgical treatment for brain arteriovenous malformations (BAVMs) after an unsuccessful first radiosurgical treatment.

Methods:

Between 1993 and 2000, 242 patients were treated by the Toronto Sunnybrook Regional Cancer Center using a LINAC system. Fifteen of these patients required a second radiosurgical intervention due to the failure of the first procedure. Data was collected on baseline patient characteristics, BAVM features, radiosurgery treatment plan and outcomes. Brain arteriovenous malformation obliteration was determined by follow-up MRI and angiography and the obliteration prediction index (OPI) calculated according to a previously established formula.

Results:

The median interval between the first and second treatment was 46 months (range 39-109). The median follow-up after the second procedure was 39 months (range 26 to 72). The mean BAVM volume before the first treatment was 8.9cm3 (range 0.3-21) and before the second treatment was 3.6cm3 (range 0.2-11.6). The mean marginal dose during the first treatment was 18Gy (range 12-25) and during the second treatment was 16Gy (range 12-20). After the second treatment, nine patients had obliteration of their BAVM confirmed by angiography and one patient had obliteration confirmed by MRI, resulting in an obliteration rate of 66.6%, which is very comparable to that predicted by the OPI (65%). After the second treatment two patients had a radiation-induced complication (13.3%).

Conclusion:

Retreatment of BAVM using a second radiosurgery procedure is a safe and effective option that offers the same rate of success as the initial radiosurgery and an acceptable risk of radiation-induced complication.

Résumé:

RÉSUMÉ: Objectif:

Analyser notre expérience de l’administration d’un second traitement radiochirurgical chez des patients atteints de malformations artérioveineuses cérébrales (MAVC) quand un premier traitement radiochirurgical a échoué.

Méthodes:

242 patients ont été traités au Sunnybrook Regional Cancer Center de Toronto au moyen du système LINAC entre 1993 et 2000. On a dû avoir recours à une seconde intervention radiochirurgicale chez quinze de ces patients, vu l’échec de la première intervention. Nous avons recueilli les données initiales sur les caractéristiques des patients, les modalités du plan de traitement radiochirurgical et les résultats. L’oblitération des MAVC était évaluée par IRM et angiographie après le traitement et l’indice de prédiction d’oblitération (IPO) était calculé selon une formule pré-établie.

Résultats:

L’intervalle médian entre le premier et le second traitement était de 46 mois (écart de 39 à 109 mois). La durée médiane du suivi après la deuxième intervention était de 39 mois (écart de 26 à 72 mois). Le volume moyen de la MAVC avant le premier traitement était de 8,9 cm3 (écart de 0,3 à 21 cm3) et avant le second traitement de 3,6 cm3 (écart de 0,2 à 11, 6cm3). La dose marginale moyenne pendant le premier traitement était de 18 Gy (écart de 12 à 25 Gy) et de 16 Gy (écart de 12 à 20 Gy) pendant le second. Neuf patients avaient une oblitération de leur MAVC confirmée par angiographie après le second traitement et un patient avait une oblitération confirmée par IRM, soit un taux d’oblitération de 66,6%. Ce taux est comparable à celui prédit par l’IPO qui était de 65%. Après le second traitement, deux patients ont présenté une complication due à l’irradiation (13%).

Conclusion:

Le recours à un second traitement radiochirurgical dans les MAVC est une option sûre et efficace qui présente le même taux de succès que le traitement radiochirurgical initial ainsi qu’un risque acceptable de complications induites par l’irradiation.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 2 , May 2006 , pp. 189 - 194
Copyright
Copyright © The Canadian Journal of Neurological 2006

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