Alpha/beta ratio for arteriovenous malformations estimated from obliteration rates after fractionated and single-dose irradiation.

BACKGROUND AND PURPOSE

Results from single-dose radiosurgery have failed to yield reasonable alpha/beta ratios for obliteration rates of arteriovenous malformations (AVMs) in the framework of the linear-quadratic approach. We used outcome data from single-dose and fractionated radiotherapy for AVM to approach this problem.

PATIENTS AND METHODS

AVM obliteration rates observed in an updated historical series of fractionated radiotherapy and from six recent series of single-dose stereotactic radiosurgery were analyzed. Reciprocal total doses (1/D) and fraction sizes (d) of isoeffective fractionation schemes were entered into the rearranged form of the linear-quadratic equation: 1/D = (alpha/E) + (beta/E)d, and alpha/beta-ratios were calculated from the parameters of the regression line.

RESULTS

Fractionated radiotherapy with 20 Gy/4 Gy fractions, 50 Gy/2 Gy fractions and single-dose radiosurgery of approximately 13 Gy were isoeffective with crude obliteration rates of 13%. The analysis yielded an alpha/beta-ratio of 3.5 Gy. For small-sized AVMs (<3 cm), alpha/beta-ratios of 4.6-6.4 Gy were obtained.

CONCLUSION

These results support the view that radiosurgery for AVM can be understood as a typical late tissue effect with a high fractionation sensitivity. Fractionated radiotherapy is ineffective for AVMs and should be evaluated carefully in other benign targets.