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Published on: April 17, 2012
Results of a Conservative Dose Plan Linear Accelerator-Based Stereotactic Radiosurgery for Pediatric Intracranial
Vedantam Rajshekhar1, Ranjith K Moorthy1, Visalakshi Jeyaseelan2
1Department of Neurological Sciences, Christian Medical College, Vellore 632004, Tamilnadu, India.
Insights
Linear accelerator-based stereotactic radiosurgery (SRS) achieved a 66.7% obliteration rate for pediatric intracranial arteriovenous malformations (AVMs). Higher radiation doses predicted successful AVM obliteration in children.
Area of Science:
- Neurology
- Radiation Oncology
- Pediatric Neurosurgery
Background:
- Intracranial arteriovenous malformations (AVMs) pose significant risks in pediatric patients.
- Stereotactic radiosurgery (SRS) using a linear accelerator (LINAC) is a treatment option for pediatric AVMs.
- Evaluating treatment efficacy and outcomes in pediatric AVMs is crucial for optimizing patient care.
Purpose of the Study:
- To assess the obliteration rate of pediatric intracranial AVMs treated with LINAC-based SRS.
- To determine the clinical outcomes and identify factors influencing treatment success.
- To evaluate the safety and effectiveness of SRS in this specific patient population.
Main Methods:
- Retrospective analysis of pediatric patients (age ≤18 years) who underwent LINAC-based SRS for AVM.
- Data collection on patient demographics, AVM characteristics, radiation dose, and follow-up outcomes.
- Statistical analysis to identify predictors of AVM obliteration and neurological complications.
Main Results:
- A total of 69 pediatric patients were included, with a median age of 14 years.
- Complete AVM obliteration was achieved in 63.8% of patients at a mean follow-up of 27.5 months.
- Higher radiation doses were significantly associated with successful AVM obliteration, while AVM volume and radiosurgery scores influenced obliteration times.
Conclusions:
- LINAC-based SRS offers a modest obliteration rate (66.7%) for pediatric intracranial AVMs.
- The radiation dose delivered is a key predictor of successful AVM obliteration.
- SRS demonstrates a low rate of neurological complications in pediatric patients with AVMs.
Objective:
To evaluate the obliteration rate and clinical outcome following linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM) in pediatric patients (age ≤18 years).
Methods:
Factors associated with the obliteration rate and neurologic complications were studied retrospectively in pediatric patients who underwent LINAC-based SRS for AVM between June 1995 and May 2014.
Results:
The study cohort comprised 36 males and 33 females, with a median age at the time of SRS of 14 years (range, 7-18 years). The mean AVM volume was 8.5 ± 8.7 cc (range, 0.6-41.8 cc). The median marginal dose of radiation delivered was 15 Gy (range, 9-20 Gy). Magnetic resonance imaging (MRI) demonstrated complete obliteration of the AVM in 44 of the 69 patients (63.8%), at a mean follow up of 27.5 months (range, 12-90 months). On subgroup analysis, 41 of the 53 AVMs of ≤14 cc in volume (77.3%) were obliterated. AVMs with a modified AVM radiosurgery score <1 had significantly shorter obliteration times from the time of SRS (P = .006). On multivariate analysis, the mean marginal dose of radiation delivered to the AVM was the sole significant predictor of obliteration (odds ratio, 1.6; 95% confidence interval, 1 to 2.4).
Conclusions:
A modest median marginal dose of 15 Gy (16 Gy in the obliterated AVM group vs. 12 Gy in the nonobliterated group) resulted in an obliteration rate of 66.7% after LINAC-based SRS for intracranial AVM, with low rate.
