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Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.

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Title: Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.
Authors: Hida, Kazutoshi Browse this author
Shirato, Hiroki Browse this author
Isu, Toyohiko Browse this author
Seki, Toshitaka Browse this author
Onimaru, Rikiya Browse this author →KAKEN DB
Aoyama, Hidefumi Browse this author
Ushikoshi, Satoshi Browse this author
Miyasaka, Kazuo Browse this author
Iwasaki, Yoshinobu Browse this author
Keywords: arteriovenous malformation
spine
intramedullary
radiation therapy
subarachnoid hemorrhage
Issue Date: Jul-2003
Publisher: American Association of Neurological Surgeons
Journal Title: Journal of Neurosurgery
Volume: 99
Issue: 1
Start Page: 34
End Page: 38
PMID: 12859056
Abstract: Object. Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. Methods. Candidates for this study were patients who experienced symptoms due to an intramedullary AVM but were ineligible for embolization or surgery. Of 21 patients with spinal AVMs, 10 cases in a 10-year period met this criterion. Angiography and contrast-enhanced computerized tomography scanning were used for treatment planning in all cases. Fractionated radiotherapy was performed using a linear accelerator, extracranial immobilization system, and frequent orthogonal linacographic verification. The starting radiation dose was 32 Gy in two, 36 Gy in three, and 40 Gy in two patients, in a regimen involving 1.8 to 2–Gy daily fractions; this was recently changed to a hypofractionation schedule of 30 Gy (in eight sessions) in one and 20 Gy (in four sessions) in two patients. Results. The follow-up period ranged from 26 to 124 months (median of 49 months). There were no hemorrhages nor any adverse reactions attributable to irradiation. Of the seven patients who consented to undergo follow-up angiography, the nidus size decreased in five, but complete obliteration did not occur in any patient. Conclusions. Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
Rights: The final version of the paper was published in J Neurosurg (Spine 1) 99:34–38, 2003. For reuse of any of the materials, including editorial copy, figures, or tables please contact the Journal of Neurosurgery at jneuro@virginia.edu
Relation: http://www.thejns-net.org/spine/issues/v99n1/abs/s0990034_fs.html
Type: article (author version)
URI: http://hdl.handle.net/2115/14693
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 飛騨 一利

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