TY - JOUR
T1 - SU‐FF‐T‐661
T2 - Investigating the Benefits of Stereotactic Light Ion Radiation Therapy for Treating Large Intracranial AVMs
AU - Andisheh, B.
AU - Mavroidis, P.
AU - Brahme, A.
AU - Bitaraf, M.
AU - Papanikolaou, N.
AU - Lind, B.
N1 - Funding Information:
This study was supported by the following NIH grants: HL49612 (to Johns Hopkins University), HL49596 and MR1 RR00055 (to the University of Chicago), HL49602 (to the University of Maryland; now Wake Forest University), HL49609 and MO1 RR00400 (to the University of Minnesota), HL58977 (to Wake Forest University), HV-48141 (to the Mammalian Genotyping Service), and HRRC 93-196 (to the University of New Mexico). We are indebted to our patients and to the families who have participated in this study. In addition to the authors, other coinvestigators and key support staff for the CSGA include the following: Johns Hopkins University—Alkis Togias, Shau Ku Huang, Linda Freidhoff, Marion Stockton, Eva Ehrlich, and Beverly Plunkett; University of Chicago—Raoul Wolf, Heidi Gidley, Rhonda Peterson, Stephanie Willadsen, Patrick Klimczyck, and Anya Tsalenko; University of Maryland (and University of New Mexico)—Shirley Murphy, Jonathon Samet, O Colin Stine, Lilly Zheng, Adam Boldt, Betsy Rechtsteiner, and Shannon Gierczak; University of Minnesota—William Oetting, Marcia Brott, Duaine Jackola, Andreas Rosenberg, Edward Corazalla, Sandra Leikam, and Lisa Daniels; and Wake Forest University (Data Coordinating Center)—June Pierce and Allison Florance. We wish to acknowledge the Observational and Safety Monitoring Board—William Busse (chair), Ellen Wijsman, and Jeffrey Chamberlain; and National Heart, Lung, and Blood Institute staff—Susan Banks-Schlegel. The Chair of the Steering Committee is rotated between the principal investigators: Carole Ober (current), Terri Beaty, Eugene Bleecker, and Malcolm Blumenthal.
PY - 2009/6
Y1 - 2009/6
N2 - Purpose The majority of complications occur in patients with large AVM volumes being treated with high doses. For large intracranial arteriovenous malformations, the special characteristics of high ionization density light ion beams offer several advantages over photon and proton beams for high dose stereotactic radiation therapy. These include a better depth dose‐distribution in tissue, negligible lateral scattering, a sharper penumbra, a steep dose fall‐off beyond the Bragg peak and a higher probability of vascular response. Material and Methods Peripheral doses and dose volume histograms (DVHs) of large AVMs were collected from different centers. Based on these data and using a maximum likelihood fitting, dose‐response parameters were derived for the Binomial model. A comparison was performed for different radiation modalities taking also into account their radiobiological differences. Results Light ion Bragg peak dose delivery has the precision required for treating very large AVMs, as well as for delivering extremely sharp focused beams to irregular lesions. For stereotactic radiosurgery with light ions, a better angiographic obliteration rate was observed. Furthermore, a lower complication rate and lower white matter necrosis was simultaneously achieved, which composed a more favorable overall clinical outcome. In patients treated by helium ion beams, a sharper dose‐response gradient was observed, which is probably related to a more homogenous radiosensitivity of the AVM nidus to ion beam radiation. Conclusion Based on this study of linear energy transfer of different therapeutic ion beams19 (H, He, Li, C), Helium or Lithium ions may be most suitable for AVM's up to 10 cm3 and for larger AVMs Lithium to carbon ions may be more appropriate. The unique physical characteristics of light ion beams are of considerable advantage for the treatment of AVMs located in front of or adjacent to sensitive and functionally important brain structures.
AB - Purpose The majority of complications occur in patients with large AVM volumes being treated with high doses. For large intracranial arteriovenous malformations, the special characteristics of high ionization density light ion beams offer several advantages over photon and proton beams for high dose stereotactic radiation therapy. These include a better depth dose‐distribution in tissue, negligible lateral scattering, a sharper penumbra, a steep dose fall‐off beyond the Bragg peak and a higher probability of vascular response. Material and Methods Peripheral doses and dose volume histograms (DVHs) of large AVMs were collected from different centers. Based on these data and using a maximum likelihood fitting, dose‐response parameters were derived for the Binomial model. A comparison was performed for different radiation modalities taking also into account their radiobiological differences. Results Light ion Bragg peak dose delivery has the precision required for treating very large AVMs, as well as for delivering extremely sharp focused beams to irregular lesions. For stereotactic radiosurgery with light ions, a better angiographic obliteration rate was observed. Furthermore, a lower complication rate and lower white matter necrosis was simultaneously achieved, which composed a more favorable overall clinical outcome. In patients treated by helium ion beams, a sharper dose‐response gradient was observed, which is probably related to a more homogenous radiosensitivity of the AVM nidus to ion beam radiation. Conclusion Based on this study of linear energy transfer of different therapeutic ion beams19 (H, He, Li, C), Helium or Lithium ions may be most suitable for AVM's up to 10 cm3 and for larger AVMs Lithium to carbon ions may be more appropriate. The unique physical characteristics of light ion beams are of considerable advantage for the treatment of AVMs located in front of or adjacent to sensitive and functionally important brain structures.
UR - https://www.scopus.com/pages/publications/85024811104
UR - https://www.scopus.com/pages/publications/85024811104#tab=citedBy
U2 - 10.1118/1.3182159
DO - 10.1118/1.3182159
M3 - Article
AN - SCOPUS:85024811104
SN - 0094-2405
VL - 36
SP - 2677
JO - Medical physics
JF - Medical physics
IS - 6
ER -