Luis Mohr, Philipp Lishewski, Markus Schymalla, Kerem Tuna Tas, Edgar Smalec, Rita Engenhart-Cabillic, André Kemmling, Maximilian Schulze, Khaled Elsayad, Fabian Eberle, Christopher Nimsky, Hilke Vorwerk, Klemens Zink, Ahmed Gawish, Sebastian Adeberg
{"title":"立体定向放射外科治疗脑动静脉畸形:单一研究所队列的长期结果评估。","authors":"Luis Mohr, Philipp Lishewski, Markus Schymalla, Kerem Tuna Tas, Edgar Smalec, Rita Engenhart-Cabillic, André Kemmling, Maximilian Schulze, Khaled Elsayad, Fabian Eberle, Christopher Nimsky, Hilke Vorwerk, Klemens Zink, Ahmed Gawish, Sebastian Adeberg","doi":"10.1007/s00066-025-02461-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The study we describe focuses on evaluating the effectiveness of linear accelerator (LINAC) stereotactic radiosurgery (SRS) in the treatment of cerebral arteriovenous malformations (AVMs). This treatment option is gaining interest due to the uncertainties associated with combined radiosurgical and endovascular treatments and the significant technological advancements in SRS. The primary goals of the study are to assess rates of obliteration (successful closure of the AVM) and rebleeding (the recurrence of bleeding posttreatment), as well as to identify factors influencing obliteration rates and to document any adverse effects associated with the procedure.</p><p><strong>Materials and methods: </strong>The study retrospectively analyzed data from 134 patients treated with LINAC-based SRS for cerebral AVMs. The patients were categorized based on their prior treatments: 50 had undergone partial embolization, 8 had received a combination of embolization and surgery and 1 patient had a surgical intervention. Furthermore, 75 patients had received no prior treatment. Kaplan-Meier survival analysis and log-rank tests were employed to calculate actuarial obliteration rates and annual cumulative bleeding rates following SRS treatment.</p><p><strong>Results: </strong>The study found that obliteration rates after SRS treatment increased over time, with 5‑year obliteration rates of 85.2% for grades I-II, 76.4% for grade III, and 62.1% for grades IV-V. Annual cumulative bleeding rates post-SRS were 1.5% for the first year and 0.7% for the second year. Interestingly, prior embolization did not affect the obliteration rate. The median time to obliteration was 36 months (range 7-162 months). Obliteration rates were significantly better in Spetzler-Martin (SM) grade I-II (85% at 5 years) compared to grade III-V (68% at 5 years, p = 0.01). Age, sex, and pediatric status had no statistically significant influence on AVM response to SRS. No radiation necrosis was observed in our cohort.</p><p><strong>Conclusion: </strong>This study contributes to the body of evidence supporting the effectiveness of SRS in treating cerebral AVMs and provides valuable insights into factors affecting treatment outcomes. The findings suggest that patients can expect a high chance of successful obliteration of the AVM with minimal adverse effects, making SRS a compelling option for those affected by this condition.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stereotactic radiosurgery for cerebral arteriovenous malformations : Evaluation of long-term outcomes in a single institute cohort.\",\"authors\":\"Luis Mohr, Philipp Lishewski, Markus Schymalla, Kerem Tuna Tas, Edgar Smalec, Rita Engenhart-Cabillic, André Kemmling, Maximilian Schulze, Khaled Elsayad, Fabian Eberle, Christopher Nimsky, Hilke Vorwerk, Klemens Zink, Ahmed Gawish, Sebastian Adeberg\",\"doi\":\"10.1007/s00066-025-02461-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The study we describe focuses on evaluating the effectiveness of linear accelerator (LINAC) stereotactic radiosurgery (SRS) in the treatment of cerebral arteriovenous malformations (AVMs). This treatment option is gaining interest due to the uncertainties associated with combined radiosurgical and endovascular treatments and the significant technological advancements in SRS. The primary goals of the study are to assess rates of obliteration (successful closure of the AVM) and rebleeding (the recurrence of bleeding posttreatment), as well as to identify factors influencing obliteration rates and to document any adverse effects associated with the procedure.</p><p><strong>Materials and methods: </strong>The study retrospectively analyzed data from 134 patients treated with LINAC-based SRS for cerebral AVMs. The patients were categorized based on their prior treatments: 50 had undergone partial embolization, 8 had received a combination of embolization and surgery and 1 patient had a surgical intervention. Furthermore, 75 patients had received no prior treatment. Kaplan-Meier survival analysis and log-rank tests were employed to calculate actuarial obliteration rates and annual cumulative bleeding rates following SRS treatment.</p><p><strong>Results: </strong>The study found that obliteration rates after SRS treatment increased over time, with 5‑year obliteration rates of 85.2% for grades I-II, 76.4% for grade III, and 62.1% for grades IV-V. Annual cumulative bleeding rates post-SRS were 1.5% for the first year and 0.7% for the second year. Interestingly, prior embolization did not affect the obliteration rate. The median time to obliteration was 36 months (range 7-162 months). Obliteration rates were significantly better in Spetzler-Martin (SM) grade I-II (85% at 5 years) compared to grade III-V (68% at 5 years, p = 0.01). Age, sex, and pediatric status had no statistically significant influence on AVM response to SRS. No radiation necrosis was observed in our cohort.</p><p><strong>Conclusion: </strong>This study contributes to the body of evidence supporting the effectiveness of SRS in treating cerebral AVMs and provides valuable insights into factors affecting treatment outcomes. The findings suggest that patients can expect a high chance of successful obliteration of the AVM with minimal adverse effects, making SRS a compelling option for those affected by this condition.</p>\",\"PeriodicalId\":21998,\"journal\":{\"name\":\"Strahlentherapie und Onkologie\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Strahlentherapie und Onkologie\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00066-025-02461-5\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Strahlentherapie und Onkologie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00066-025-02461-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Stereotactic radiosurgery for cerebral arteriovenous malformations : Evaluation of long-term outcomes in a single institute cohort.
Objective: The study we describe focuses on evaluating the effectiveness of linear accelerator (LINAC) stereotactic radiosurgery (SRS) in the treatment of cerebral arteriovenous malformations (AVMs). This treatment option is gaining interest due to the uncertainties associated with combined radiosurgical and endovascular treatments and the significant technological advancements in SRS. The primary goals of the study are to assess rates of obliteration (successful closure of the AVM) and rebleeding (the recurrence of bleeding posttreatment), as well as to identify factors influencing obliteration rates and to document any adverse effects associated with the procedure.
Materials and methods: The study retrospectively analyzed data from 134 patients treated with LINAC-based SRS for cerebral AVMs. The patients were categorized based on their prior treatments: 50 had undergone partial embolization, 8 had received a combination of embolization and surgery and 1 patient had a surgical intervention. Furthermore, 75 patients had received no prior treatment. Kaplan-Meier survival analysis and log-rank tests were employed to calculate actuarial obliteration rates and annual cumulative bleeding rates following SRS treatment.
Results: The study found that obliteration rates after SRS treatment increased over time, with 5‑year obliteration rates of 85.2% for grades I-II, 76.4% for grade III, and 62.1% for grades IV-V. Annual cumulative bleeding rates post-SRS were 1.5% for the first year and 0.7% for the second year. Interestingly, prior embolization did not affect the obliteration rate. The median time to obliteration was 36 months (range 7-162 months). Obliteration rates were significantly better in Spetzler-Martin (SM) grade I-II (85% at 5 years) compared to grade III-V (68% at 5 years, p = 0.01). Age, sex, and pediatric status had no statistically significant influence on AVM response to SRS. No radiation necrosis was observed in our cohort.
Conclusion: This study contributes to the body of evidence supporting the effectiveness of SRS in treating cerebral AVMs and provides valuable insights into factors affecting treatment outcomes. The findings suggest that patients can expect a high chance of successful obliteration of the AVM with minimal adverse effects, making SRS a compelling option for those affected by this condition.
期刊介绍:
Strahlentherapie und Onkologie, published monthly, is a scientific journal that covers all aspects of oncology with focus on radiooncology, radiation biology and radiation physics. The articles are not only of interest to radiooncologists but to all physicians interested in oncology, to radiation biologists and radiation physicists. The journal publishes original articles, review articles and case studies that are peer-reviewed. It includes scientific short communications as well as a literature review with annotated articles that inform the reader on new developments in the various disciplines concerned and hence allow for a sound overview on the latest results in radiooncology research.
Founded in 1912, Strahlentherapie und Onkologie is the oldest oncological journal in the world. Today, contributions are published in English and German. All articles have English summaries and legends. The journal is the official publication of several scientific radiooncological societies and publishes the relevant communications of these societies.