Hypofractionated stereotactic radiotherapy in medium-sized to large arteriovenous malformations

We have reviewed treatment results in terms of obliteration and complications in 24 patients with medium to large sized cerebral arteriovenous malformations (AVMs) (mean volume 18.5 ± 8.9 cm3; range: 10–42) treated with hypofractionated stereotactic radiotherapy (HSRT). AVMs are congenital lesions associated with a high morbidity and mortality. Radiosurgery is one option for treatment. However, in larger AVMs with volumes exceeding 10 cm3 obliteration rates are less favourable and radiation induced complications more frequent. For larger AVMs, volume-staged radiosurgery is one option while another option may be the use of HSRT. Patients were treated with 6–7 Gy in five fractions to a total dose of 30–35 Gy (mean total dose 32.9 ± 1.6 Gy [standard error of the mean]). Sixteen patients (69.6%) showed obliteration after a mean time of 35.2 ± 14.8 months (range: 24–60). Only one patient (4.2%) experienced symptomatic radionecrosis. Our treatment with HSRT seems safe and efficient for treatment of medium to large sized AVMs. Treatment results seem to be in line with volume-staged radiosurgery and may be an alternative for AVMs not suitable for single fraction radiosurgery.