AVM/Cavernoma-Any theoretical benefit to fractionation

[xrt123]

Just wondering if anyone has any thoughts on whether fractionated SRS would provide any theoretical benefit compared to single fraction. Evidence points to needing a high dose per fraction for endothelial damage, but with fractionation there is less likely to be radionecrosis. There seems to be very little in the literature on FSRT. Thoughts?

(Please don't create a segway into a job market discussion)

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[Gfunk6]

In AVM treatment most people used the term "staged" SRS rather than fractionated. Here is an abstract published by Mayo a couple of years ago on the subject: http://www.redjournal.org/article/S0360-3016(16)30767-2/fulltext

 

[Neuronix]

Staged is more for huge AVMs to treat the AVM in parts to mitigate the high risk of radiation necrosis if treated all at once.

If anything the rationale is stronger for radiosurgical doses for vascular malformations. In animal models, the vascular endothelium is damaged and collapses over doses of 8 Gy.

 

[nkmiami]

I fractionated one case over my career, because it was large, and at the time patient did not want head frame placed multiple times for staged procedure. Given you are trying to injure normal tissue, I am not sure why fractionation would be advantageous