• Henrik Hauswald, Stefanie Milker-Zabel, Florian Sterzing, Wolfgang Schlegel, Juergen Debus, and Angelika Zabel-du Bois.
• Department of Radiation Oncology, University of Heidelberg, Germany. Henrik.Hauswald@med.uni-heidelberg.de
• Radiother Oncol. 2011 Feb 1;98(2):217-22.

BackgroundAim was to access outcome and toxicity of repeated linac-based radiosurgery in incompletely obliterated cerebral AVM.Patients And MethodsBetween 1998 and 2008, 11 patients were treated with repeated radiosurgery. The median dose to the 80%-isodose was 15 Gy (range, 12-18 Gy). During initial radiosurgery the median dose was 18 Gy (range, 9-22 Gy).ResultsThe median time interval between initial radiosurgery and re-treatment was 9 years (range, 4-16 years). The median follow-up was 26 months (range, 2-115 months). Treatment response was seen in 8 patients (89%). Complete (partial) obliteration was achieved in 5 (3) patients (56%, 33%, respectively).The median time to complete obliteration was 26 months (range, 5-45 months). Pre-existing neurological symptoms improved in 2 patients (18%), were stable in 7 patients (64%) and worsened in 2 patients (18%). Prevalence of intracranial hemorrhage was 9% (1/11). Post-re-treatment intracranial hemorrhage rate was 2.7% (1/38 years at risk). During follow-up, no secondary malignancies or toxicity>grade III were observed.ConclusionRepeated linac-based radiosurgery in incompletely obliterated cerebral AVM is an effective treatment option with a high rate of treatment response and an acceptable risk for side effects. Marginal doses above 15 Gy might further improve the rate of complete obliterations.Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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