• Victoria B Anthes, Michael Schwartz, Michael Cusimano, Ivan Radovanovic, Abhaya V Kulkarni, Normand Laperriere, David Payne, Robert Heaton, Monique van Prooijen, Sunit Das, and Derek S Tsang.
• Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada.
• Neurosurgery. 2024 Mar 1; 94 (3): 575583575-583.

Background And ObjectivesStereotactic radiosurgery (SRS) marginal dose is associated with successful obliteration of cerebral arteriovenous malformations (AVM). SRS dose rate-how old the cobalt-60 sources are-is known to influence outcomes for some neurological conditions and benign tumors. The objective of this study was to determine the association between cobalt-60 treatment dose rate and cerebral AVM obliteration in patients treated with SRS.MethodsWe performed a retrospective cohort study of 361 patients undergoing 411 AVM-directed SRS treatments between 2005 and 2019 at a single institution. Lesion characteristics, SRS details, obliteration dates, and post-treatment toxicities were recorded. Univariate and multivariate regression analyses of AVM outcomes regarding SRS dose rate (range 1.3-3.7 Gy, mean = 2.4 Gy, median = 2.5 Gy) were performed.ResultsAt 10 years post-SRS, 68% of AVMs were obliterated on follow-up imaging. Dose rates >2.9 Gy/min were found to be significantly associated with AVM obliteration compared with those <2.1 Gy/min ( P = .034). AVM size, biologically effective dose, and SRS marginal dose were also associated with obliteration, with obliteration more likely for smaller lesions, higher biologically effective dose, and higher marginal dose. Higher dose rates were not associated with the development of post-SRS radiological or symptomatic edema, although larger AVM volume was associated with both types of edema.ConclusionPatients with cerebral AVMs treated with higher SRS dose rates (from newer cobalt-60 sources) experience higher incidences of obliteration without a significant change in the risk of post-treatment edema.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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