Possible fractionated regimens for image-guided intensity-modulated radiation therapy of large arteriovenous malformations

Phys Med Biol. 2007 Sep 21;52(18):5667-82. doi: 10.1088/0031-9155/52/18/013. Epub 2007 Sep 4.

Abstract

The aim of this study was to estimate a plausible alpha/beta ratio for arteriovenous malformations (AVMs) based on reported clinical data, and to design possible fractionation regimens suitable for image-guided intensity-modulated radiation therapy (IG-IMRT) for large AVMs based on the newly obtained alpha/beta ratio. The commonly used obliteration rate (OR) for AVMs with a three year angiographic follow-up from many institutes was fitted to linear-quadratic (LQ) formalism and the Poisson OR model. The determined parameters were then used to calculate possible fractionation regimens for IG-IMRT based on the concept of a biologically effective dose (BED) and an equivalent uniform dose (EUD). The radiobiological analysis yields a alpha/beta ratio of 2.2 +/- 1.6 Gy for AVMs. Three sets of possible fractionated schemes were designed to achieve equal or better biological effectiveness than the single-fraction treatments while maintaining the same probability of normal brain complications. A plausible alpha/beta ratio was derived for AVMs and possible fractionation regimens that may be suitable for IG-IMRT for large AVM treatment are proposed. The sensitivity of parameters on the calculation was also studied. The information may be useful to design new clinical trials that use IG-IMRT for the treatment of large AVMs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dose Fractionation, Radiation
  • Feasibility Studies
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / surgery*
  • Radiography
  • Radiosurgery / methods*
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy, Conformal / methods*
  • Surgery, Computer-Assisted / methods*