Summary
Purpose. Presentation of intensity-modulated radiosurgery (IMRS) for the treatment of inoperable, complex shaped pediatric arterio-venous malformations AVM.
Method. Between 03/99 and 11/04, IMRS was delivered to seven children aged six to 18 years. Prescribed minimum doses ranged from 17.5 to 20 Gy (median 18 Gy). Radiosurgery planning and delivery used a serial tomotherapeutic IMRT technique (Peacock IMRT, North American Scientific/Nomos, Cranberry Township, PA) over two to four couch angles. A linear accelerator attached binary multi-leaf collimator was used to generate pencil beams of 10 mm by either 8.5 or 4.0 mm. Treatment planning employed an inverse treatment planning optimization algorithm. Parameters submitted to the treatment planning system were: prescription dose (PD), volume of target allowed to receive less dose (standard 3%), minimum dose (0.5 Gy less than PD), and maximum dose (200% of PD). Planning system specific IMRS target and tissue types were selected to prioritize dose conformality over dose homogeneity. The prescription isodose encompassed at least 95% of the target volume. We calculated conformality (CI) and homogeneity indices (HI) to characterize the quality of IMRS plans, and summarized preliminary clinical outcomes.
Findings. Target volumes ranged from 0.71 to 63.02 cm3 (median 13.8 cm3, 6/7 AVM larger than 10 cm3). Median CI was 1.07 (range 1.05 to 1.7) according to RTOG criteria. Median HI was 1.12 (range 1.09 to 1.23). During limited follow-up (median 32 months, range 5 to 53 months), two AVM completely obliterated at 19 and 22 months, and partial obliteration (>75%) was observed in three cases. No treatment-related side effects, other than acute nausea and temporary headaches interpreted as being associated with changes in cerebral blood distribution, were observed.
Conclusions. IMRS can allow for highly conformal planning and delivery of radiosurgery radiation doses even if pediatric AVM target volumes are large and/or highly complex in shape. This technique has been seen to result in favorable preliminary outcomes, thus supporting future exploration of this technique in pediatric and adult patients.
Similar content being viewed by others
References
EM Altschuler LD Lunsford RJ Coffey et al. (1989) ArticleTitleGamma knife radiosurgery for intracranial arteriovenous malformations in childhood and adolescence. Pediatr Neurosci 15 53–61 Occurrence Handle2699658
SH Benedict RM Cardinale Q Wu et al. (2001) ArticleTitleIntensity-modulated stereotactic radiosurgery using dynamic micro-multileaf collimation. Int J Radiat Oncol Biol Phys 50 751–758 Occurrence Handle10.1016/S0360-3016(01)01487-0 Occurrence Handle11395244
JA Borden A Mahajan JS Tsai (2000) ArticleTitleA quality factor to compare the dosimetry of gamma knife radiosurgery and intensity-modulated radiation therapy quantitatively as a function of target volume and shape. Technical note. J Neurosurg 93 IssueID[Suppl] 3 228–232 Occurrence Handle11143254
RM Cardinale SH Benedict Q Wu et al. (1998) ArticleTitleA comparison of three stereotactic radiotherapy techniques; ARCS vs. noncoplanar fixed fields vs. intensity modulation. Int J Radiat Oncol Biol Phys 42 431–436 Occurrence Handle10.1016/S0360-3016(98)00206-5 Occurrence Handle9788426
C Di Rocco G Tamburrini M Rollo (2000) ArticleTitleCerebral arteriovenous malformations in children. Acta Neurochir (Wien) 142 145–156 Occurrence Handle10.1007/s007010050017
M Fuss K Poljanc EB Hug (2000) ArticleTitleFull Scale IQ (FSIQ) changes in children treated with whole brain and partial brain irradiation. A review and analysis. Strahlenther Onkol 176 573–581 Occurrence Handle11140152
R Garza-Mercado E Cavazos D Tamez-Montes (1987) ArticleTitleCerebral arteriovenous malformations in children and adolescents. Surg Neurol 27 131–140 Occurrence Handle10.1016/0090-3019(87)90284-9 Occurrence Handle3810441
BL Hoh CS Ogilvy WE Butler et al. (2000) ArticleTitleMultimodality treatment of nongalenic arteriovenous malformations in pediatric patients. Neurosurgery 47 346–357 Occurrence Handle10.1097/00006123-200008000-00015 Occurrence Handle10942007
BA Kramer DE Wazer MJ Engler et al. (1998) ArticleTitleDosimetric comparison of stereotactic radiosurgery to intensity modulated radiotherapy. Radiat Oncol Investig 6 18–25 Occurrence Handle10.1002/(SICI)1520-6823(1998)6:1<18::AID-ROI3>3.0.CO;2-L Occurrence Handle9503486
C Kulik JM Caudrelier M Vermandel et al. (2002) ArticleTitleConformal radiotherapy optimization with micromultileaf collimators: comparison with radiosurgery techniques. Int J Radiat Oncol Biol Phys 53 1038–1050 Occurrence Handle10.1016/S0360-3016(02)02863-8 Occurrence Handle12095573
DD Leavitt G Watson M Tobler et al. (2001) ArticleTitleIntensity-modulated radiosurgery/radiotherapy using a micromultileaf collimator. Med Dosim 26 143–150 Occurrence Handle10.1016/S0958-3947(01)00068-1 Occurrence Handle11444516
EI Levy A Niranjan TP Thompson et al. (2000) ArticleTitleRadiosurgery for childhood intracranial arteriovenous malformations. Neurosurgery 47 834–841 Occurrence Handle10.1097/00006123-200010000-00008 Occurrence Handle11014422
JS Loeffler E Rossitch SuffixJr R Siddon et al. (1990) ArticleTitleRole of stereotactic radiosurgery with a linear accelerator in treatment of intracranial arteriovenous malformations and tumors in children. Pediatrics 85 774–782 Occurrence Handle2184409
T Menovsky JJ van Overbeeke (1997) ArticleTitleCerebral arteriovenous malformations in childhood: state of the art with special reference to treatment. Eur J Pediatr 156 741–746 Occurrence Handle10.1007/s004310050703 Occurrence Handle9365059
C Millar B Bissonnette RP Humphreys (1994) ArticleTitleCerebral arteriovenous malformations in children. Can J Anaesth 41 321–331 Occurrence Handle8004740
RK Mulhern J Hancock D Fairclough et al. (1992) ArticleTitleNeuropsychological status of children treated for brain tumors: a critical review and integrative analysis. Med Pediatr Oncol 20 181–191 Occurrence Handle1574027
JL Nakamura A Pirzkall MP Carol et al. (2003) ArticleTitleComparison of intensity-modulated radiosurgery with gamma knife radiosurgery for challenging skull base lesions. Int J Radiat Oncol Biol Phys 55 99–109 Occurrence Handle10.1016/S0360-3016(02)03806-3 Occurrence Handle12504041
BE Pollock LD Lunsford D Kondziolka et al. (1994) ArticleTitlePatient outcomes after stereotactic radiosurgery for “operable” arteriovenous malformations. Neurosurgery 35 1–7 Occurrence Handle7936129
D Riva C Pantaleoni M Devoti et al. (1997) ArticleTitleRadiosurgery for cerebral AVMs in children and adolescents: the neurobehavioral outcome. J Neurosurg 86 207–210 Occurrence Handle9010421
DD Roman PW Sperduto (1995) ArticleTitleNeuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys 31 983–998 Occurrence Handle10.1016/0360-3016(94)00550-8 Occurrence Handle7860415
BJ Salter M Fuss DG Vollmer et al. (2001) ArticleTitleThe TALON removable head frame system for stereotactic radiosurgery/radiotherapy: measurement of the repositioning accuracy. Int J Radiat Oncol Biol Phys 51 555–562 Occurrence Handle10.1016/S0360-3016(01)01670-4 Occurrence Handle11567832
V Sankaranarayanan S Ganesan S Oommen et al. (2003) ArticleTitleStudy on dosimetric parameters for stereotactic radiosurgery and intensity-modulated radiotherapy. Med Dosim 28 85–90 Occurrence Handle10.1016/S0958-3947(02)00238-8 Occurrence Handle12804705
E Shaw R Kline M Gillin et al. (1993) ArticleTitleRadiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 27 1231–1239 Occurrence Handle8262852
MD Smyth PK Sneed SF Ciricillo et al. (2002) ArticleTitleStereotactic radiosurgery for pediatric intracranial arteriovenous malformations: the University of California at San Francisco experience. J Neurosurg 97 48–55 Occurrence Handle12134932
SY Woo WH Grant Suffix3rd D Bellezza et al. (1996) ArticleTitleA comparison of intensity modulated conformal therapy with a conventional external beam stereotactic radiosurgery system for the treatment of single and multiple intracranial lesions. Int J Radiat Oncol Biol Phys 35 593–597 Occurrence Handle10.1016/S0360-3016(96)80023-X Occurrence Handle8655384
M Yamamoto M Jimbo M Ide et al. (1992) ArticleTitleLong-term follow-up of radiosurgically treated arteriovenous malformations in children: report of nine cases. Surg Neurol 38 95–100 Occurrence Handle10.1016/0090-3019(92)90084-Z Occurrence Handle1509353
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fuss, M., Salter, B., Caron, JL. et al. Intensity-modulated radiosurgery for childhood arteriovenous malformations. Acta Neurochir (Wien) 147, 1141–1150 (2005). https://doi.org/10.1007/s00701-005-0572-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-005-0572-9