1. There was no difference between elderly patients (≥60 years) and non-elderly patients in the occurrence of adverse outcomes following radiosurgery for arteriovenous malformation.
2. Elderly age was not predictive of arteriovenous malformation obliteration, radiation-induced changes or hemorrhage following radiosurgery.
Evidence Rating Level: 2 (Good)
Study Rundown: Cerebral arteriovenous malformation (AVM) is uncommon among elderly patients; however, the incidence is rising in concert with increases in life expectancy. While previous studies have shown that age is associated with worse surgical outcomes, there is a shortage of evidence on post-radiosurgery outcomes in the elderly population. This study aimed to analyze and characterize outcomes following radiosurgical AVM treatment in elderly patients. The authors found that the achievement of AVM obliteration was similar between the elderly (≥60 years) and non-elderly cohorts. Likewise, there was no difference in the occurrence of radiation-induced changes (RIC). The incidence rate of post-radiosurgery hemorrhage was comparable between the elderly and non-elderly cohorts as well. Elderly age was not a significant predictor for AVM obliteration, RIC and post-radiosurgery hemorrhage. This study was strengthened by the use of multiple outcome measures and matching cohorts. However, this study was limited by its retrospective, single-center design and potential selection and treatment bias.
In-Depth [retrospective cohort]: Researchers reviewed 132 AVM patient files, with 66 patients in each of the elderly and non-elderly cohorts. Patients were treated with stereotactic radiosurgery at the University of Virginia between 1989 and 2013. The inclusion criteria for the elderly cohort were as follows: 1) patient age 60 years or more 2) sufficient clinical and patient data 3) minimum of 2 years radiologic follow-up or complete AVM obliteration. Propensity score matching was used to match elderly AVM patients to non-elderly subjects in a 1:1 fashion based on clinical features related to AVM, such as nidus volume and AVM location. Outcomes included achievement of AVM obliteration, presence of RIC, and the occurrence of AVM-related hemorrhage. There were no differences in the baseline characteristics between two cohorts with the exception of age, the number of isocenters in the treatment plan, and a radiosurgery AVM score system, which incorporated age in its formula. There was no difference in the rate of AVM obliteration between the elderly and the non-elderly cohorts (66.7% vs. 69.7%, respectively, p = 0.709). In addition, there was no significant difference in the rates of radiographically evident, symptomatic and permanent RIC between the 2 groups (p = 0.188, 0.345, 0.316, respectively). Lastly, the rate of hemorrhage was not significantly different between the elderly and the non-elderly cohorts (1.1% vs. 2.0%, p = 0.300). Elderly age was not found to be significant predictor for any of the outcome measures.
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