Dosimetric comparison of photon and proton radiosurgery for large arteriovenous malformations.

Roman L Travis, Travis J Atchley, Martha H Chadband, Michael H Soike, Michael C Dobelbower, Philip G R Schmalz

Abstract read

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Article in Journal of radiosurgery and SBRT, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Roman L TravisDepartment of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.

Travis J AtchleyDepartment of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.

Martha H ChadbandDepartment of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.

Michael H SoikeDepartment of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.

Michael C DobelbowerDepartment of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.

Philip G R SchmalzDepartment of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: Radiosurgery for large arteriovenous malformations (AVMs) is limited by toxicity from dose spillage into normal brain, worsened by larger gradient indices in bigger targets. Proton radiosurgery theoretically reduces integral dose but has greater uncertainty due to robust planning constraints and fewer beam angles. This study evaluates whether pencil beam scanning radiosurgery (PBSR) improves normal brain dosimetry while maintaining comparable target coverage to photon radiosurgery. Methods: The 10 largest AVMs treated with photon radiosurgery at a single institution were re-planned for PBSR in Varian Eclipse. Proton plans incorporated a 2% computed tomography (CT) density correction and 2 mm range uncertainty, with 2-4 beams per institutional practice. Plans prioritized isotoxicity to organs at risk (OARs) before matching target coverage. Dosimetric metrics were compared using a paired Results: Median AVM size was 36.6 cc (24.3-60.1 cc). All plans prescribed 1750 cGy in one fraction. PBSR had higher gradient indices and reduced target coverage near OARs compared to photon radiosurgery. While PBSR lowered normal brain mean dose and Conclusions: PBSR, as planned with current institutional constraints, leads to greater high-dose spill into normal brain and inferior target coverage near OARs. Future improvements in PBSR, such as dual-energy CT, additional beam angles, and LET-based planning, may help mitigate these limitations.

Indexed as

arteriovenous malformationproton beam therapyradiosurgery

Identifiers

PMID41409186

PMCPMC12708002

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.