Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis

Zhexi He; Man Kit Jason Ho; Wan Yan Venus Lee; Hing Yuen Law; Yee Wa Victy Wong; To-Wai Leung; Wing Ho Mui; Sui-To Wong; Chi Sing Frank Wong; Kwong Yui Yam

doi:10.1016/j.ctro.2023.100642

Frameless versus frame-based stereotactic radiosurgery for intracranial arteriovenous malformations: A propensity-matched analysis

Clin Transl Radiat Oncol. 2023 May 26:41:100642. doi: 10.1016/j.ctro.2023.100642. eCollection 2023 Jul.

Authors

Affiliations

¹ Department of Neurosurgery, Tuen Mun Hospital, N.T., Hong Kong, China.
² Department of Clinical Oncology, Tuen Mun Hospital, N.T., Hong Kong, China.

Abstract

Objective: The frameless linear accelerator (LINAC) based stereotactic radiosurgery (SRS) has been evolving with a reduction in patient discomfort. However, there was limited evidence comparing frame-based and frameless SRS for intracranial arteriovenous malformations (AVM). We aimed to compare the treatment outcomes between frame-based and frameless LINAC SRS.

Materials and methods: This retrospective cohort compared the outcomes of frame-based LINAC SRS (1998-2009) with frameless LINAC SRS (2010-2020). The primary outcome was the obliteration rate. The other outcomes included the neurological, radiological, and functional outcomes after SRS. A matched cohort was identified by propensity scores for further comparisons.

Results: A total of 65 patients were included with a mean follow-up time of 13.2 years (158.5 months). There were 40 patients in the frame-based group and 25 patients in the frameless group. The overall obliteration rate was comparable (Frame-based 82.5% vs Frameless 80.0%, p = 0.310) and not significantly different over time (log-rank p = 0.536). The crude post-SRS hemorrhage rate was 1.5% and the incidence was 0.3 per 100 person-years. There were 67.7% of patients with AVM obliteration without new persistent neurological deficits at the last visit and 56.9% of patients with AVM obliteration without any deficits (transient or persistent) during the entire follow-up period. Four patients (8.0%) developed late onset persistent adverse radiation effects (more than 96 months after SRS) among 50 patients with more than 8-year surveillance. In the propensity-matched cohort of 42 patients, there was no significant difference in AVM obliteration (Frame-based vs Frameless, log-rank p = 0.984).

Conclusion: Frameless and frame-based LINAC SRS have comparable efficacy in intracranial AVM obliteration. A longer follow-up duration may further characterize the rate of late adverse radiation effects in frameless SRS.

Keywords: Adverse radiation effect; Frameless radiosurgery; Intracranial arteriovenous malformations; Linear accelerator; Mask-based radiosurgery; Obliteration rate; Stereotactic radiosurgery.