Failure of Conventionally Fractionated Radiotherapy to Decrease the Risk of Hemorrhage in Inoperable Arteriovenous Malformations

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Abstract
Twenty-six patients with arteriovenous malformations (AVMs) were treated between 1965 and 1986 with conventional fractionated radiotherapy at the Royal Marsden Hospital. There were 14 male patients and 12 female, aged 11 to 57 years (median, 24 yr). Twenty-five patients completed radiotherapy with a localized treatment target volume of a dose of 40 to 54 Gy. The median follow-up was 14.5 years. Eleven patients had an additional hemorrhage. The actuarial annual risk of bleeding was 2.3%, which is similar to that found in untreated patients. Follow-up angiograms were performed in 11 patients, and 10 showed persistence of AVM. The results suggest that fractionated radiotherapy in conventional doses does not make a large impact on the risk of hemorrhage in patients with inoperable AVMs, and, where possible, stereotactic external beam radiotherapy/radiosurgery should be employed.