Aims: The purpose of this investigation was to assess the obliteration rate and complications following different radiation schedules of hypofractionated conformal stereotactic radiotherapy for cerebral arteriovenous malformations (AVMs). Methods: Twenty-five patients were treated with 35 Gy in 5 fractions, whereas 31 patients were treated with 30–32.5 Gy (mean: 31.6 ± 0.23 Gy) in 5 fractions. A complete angiographic follow-up is available for 40 patients. Results: Thirty-seven out of 40 patients (92.5%) have so far shown obliteration of their AVMs after a mean time of 3.2 ± 0.26 years (range: 2–8 years). The mean AVM volume in these patients was 8.2 ± 1.0 cm3 (range: 1.5–29 cm3). There was a higher rate of obliteration (88%) in patients treated with 35 Gy compared to those treated with <35 Gy (78%), even if this was not statistically significant. There was a significantly shorter time to obliteration in patients treated with 35 Gy. All patients who experienced symptomatic radionecrosis belonged to the group treated with 35 Gy. Conclusion: A radiation schedule of 35 Gy in 5 fractions may be more effective than a radiation schedule of <35 (30–32.5) Gy in obliterating AVMs. This may, however, be at the price of an increased risk of symptomatic radionecrosis.

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