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Cited by 295Vascular Malformations Diagnosis and TreatmentRadiation Therapy and DosimetryVascular Malformations and Hemangiomas

Stereotactic heavy-charged-particle bragg-peak radiation for intracranial arteriovenous malformations

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Steinberg, Gary K., Fabrikant, Jacob I., Marks, Michael P., Levy, Richard P., Frankel, Kenneth A., Phillips, Mark H., Shuer, Lawrence M., Silverberg, Gerald D.·1990·New England Journal of Medicine
DOI 10.1056/nejm199007123230205
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Abstract

BACKGROUND: Heavy-charged-particle radiation has several advantages over protons and photons for the treatment of intracranial lesions; it has an improved physical distribution of the dose deep in tissue, a small angle of lateral scattering, and a sharp distal falloff of the dose. METHODS: We present detailed clinical and radiologic follow-up in 86 patients with symptomatic but surgically inaccessible cerebral arteriovenous malformations that were treated with stereotactic helium-ion Bragg-peak radiation. The doses ranged from 8.8 to 34.6 Gy delivered to volumes of tissue of 0.3 to 70 cm3. RESULTS: Two years after radiation treatment, the rate of complete obliteration of the lesions, as detected angiographically, was 94 percent for lesions smaller than 4 cm3, 75 percent for those of 4 to 25 cm3, and 39 percent for those larger than 25 cm3. After three years, the rates of obliteration were 100, 95, and 70 percent, respectively. Major neurologic complications occurred in 10 patients (12 percent), of whom 8 had permanent deficits. All these complications occurred in the initial stage of the protocol, before the maximal dose of radiation was reduced to 19.2 Gy. In addition, hemorrhage occurred in 10 patients from residual malformations between 4 and 34 months after treatment. Seizures and headaches were less severe in 63 percent of the 35 and 68 percent of the 40 patients, respectively, who had them initially. CONCLUSIONS: Given the natural history of these inaccessible lesions and the high risks of surgery, we conclude that heavy-charged-particle radiation is an effective therapy for symptomatic, surgically inaccessible intracranial arteriovenous malformations. The current procedure has two disadvantages: a prolonged latency period before complete obliteration of the vascular lesion and a small risk of serious neurologic complications.

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  • Ionizing radiation can damage the CNS, causing changes to cognitive function, inducing fatigue, and generating performance decrements.

    “Ionizing radiation can damage the CNS, causing changes to cognitive function, inducing fatigue, and generating performance decrements [2,30,42,43,44,45,46,47,48,49,50,51].”

    From Space Radiation: The number one risk to astronaut health beyond low earth orbit (2014) · cites this paper as [49]

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  1. [3]3. Idem. Radiosurgery. Neurosurgery 1989; 25:670-2.
  2. [2]2. Kjellberg RN. Proton beam therapy for arteriovenous malformations of the brain. In: Schmidek HH, Sweet WH, eds. Operative neurosurgical techniques: indications, methods and results. 2nd ed. Vol. 2. Philadelphia: W.B. Saunders, 1988:911-5.
  3. [11]11. Stein BM. Surgical decisions in vascular malformations of the brain. In: Barnett HJM, Stein BM, Mohr JP, Yatsu FM, eds. Stroke: pathophysiology, diagnosis, and management. Vol. 2. New York: Churchill Livingstone, 1986:1129-72.
  4. [19]19. Marks MP, Delapaz RL, Fabrikant JI, et al. Intracranial vascular malformaoda ee det as - ai ds. Radiology 1988; 168:447-55.
  5. [7]7. Steinberg GK, Silverberg GD, Fabrikant JI, et al. Preliminary results of heavy particle radiation for arteriovenous malformations of the brain. Stroke 1988; 19:149. abstract.

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Authors
Steinberg, G. K., Fabrikant, J. I., Marks, M. P., Levy, R. P., Frankel, K. A., Phillips, M. H., Shuer, L. M., & Silverberg, G. D.
Affiliations
  • Stanford Medicine (US)
  • Lawrence Berkeley National Laboratory (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1990-07-12
Volume
323
Issue
2
Pages
96-101
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199007123230205
OpenAlex
W2037803738
Cited by
295
References
23
Citations by year
2025: 1 · 2024: 3 · 2022: 4 · 2020: 3 · 2018: 1 · 2016: 4 · 2015: 8 · 2014: 7 · 2013: 5 · 2012: 9
FWCI
17.10
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Vascular Malformations Diagnosis and Treatment
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Radiation Therapy and Dosimetry
  • Health Sciences › Medicine › Surgery › Vascular Malformations and Hemangiomas
Keywords
intracranial arteriovenous malformations, helium ion therapy, stereotactic radiotherapy, Bragg peak, neurological complications, hemorrhage, seizures, headache
MeSH terms
Adolescent, Adult, Aged, Cerebral Angiography, Intracranial Arteriovenous Malformations, Cerebral Hemorrhage, Child, Female, Follow-Up Studies, Helium, Humans, Male, Middle Aged, Radiotherapy, Radiotherapy Dosage

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