Stereotactic irradiation for intracranial arteriovenous malformation using stereotactic radiosurgery or hypofractionated stereotactic radiotherapy
Stereotactic irradiation for intracranial arteriovenous malformation using stereotactic radiosurgery or hypofractionated stereotactic radiotherapy
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DOI：
10.1016/j.ijrobp.2004.04.041
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发表时间：
2004-11-01
影响因子：
7
通讯作者：
Miyasaka, K
中科院分区：
文献类型：
--
作者：
Chang, TC;Shirato, H;Miyasaka, K
目的：探讨采用大分割立体定向放射治疗（HSRT）和立体定向放射外科（SRS）联合使用大分割立体定向放射治疗（HSRT）和立体定向放射外科（SRS）治疗位于显着区域或较大动静脉畸形（AVM）以及单独使用SRS治疗其他动静脉畸形（AVM）的立体定向放射治疗策略的适当性。 方法和材料：本研究包括72名患者的75例AVM，平均随访时间为52个月。在 75 个 AVM 中，33 个位于雄辩区域或最大直径 > 2.5 cm，如果患者同意延长佩戴立体定向框架 5 天，则在单个等中心每天分四次给予 25-35 Gy（平均 32.4 Gy）。其他 42 个 AVM 在等中心点接受 SRS 治疗，剂量为 15-25 Gy（平均 24.1 Gy）。 75个AVM根据Spetzler-Martin分级系统进行分类； 21、23、28、2 和 1 例 AVM 分别为 I、II、III、IV、V 和 VI 级。 结果：3 年时总体精算闭塞率为 43%（95% 置信区间 [CI]，30-56%），5 年时为 72%（95% CI，58-86%），5 年为 78%（95% CI，58%）。 63-93%）6岁时。 42 个 2 cm AVM 的 5 年精算闭塞率为 79%。 HSRT 后 5 年和 6 年精算消失率分别为 61%（95% CI，39-83%）和 71%（95% CI，47-95%），SRS 后分别为 81%（95% CI，66-96%）和 81%（95% CI，66-96%）；差异无统计学意义。在 SRS 组的 4 名受试者和 HSRT 组的 1 名受试者中观察到辐射引起的坏死。 SRS 组有 3 名患者出现囊肿形成，HSRT 组没有患者出现囊肿形成。 3 例（4.2%）出现永久性症状并发症，3 例中有 1 例死亡。所有 3 名患者均属于 SRS 组。所有患者的年颅内出血率为 5.5-5.6%。结论：我们使用 SRS 和 HSRT 的治疗策略与单独使用 SRS 的策略一样有效。建议 HSRT 方案比高剂量 SRS 方案具有较低的放射性坏死和囊肿形成频率。 HSRT 与低剂量 SRS 相比的益处尚未确定。 (C) 2004 年爱思唯尔公司。
Purpose: To investigate the appropriateness of the treatment policy of stereotactic irradiation using both hypofractionated stereotactic radiotherapy (HSRT) and stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) located in an eloquent region or for large AVMs and using SRS alone for the other AVMs.Methods and Materials: Included in this study were 75 AVMs in 72 patients, with a mean follow-up of 52 months. Of the 75 AVMs, 33 were located in eloquent regions or were >2.5 cm in maximal diameter and were given 25-35 Gy (mean, 32.4 Gy) in four daily fractions at a single isocenter if the patient agreed to prolonged wearing of the stereotactic frame for 5 days. The other 42 AVMs were treated with SRS at a dose of 15-25 Gy (mean, 24.1 Gy) at the isocenter. The 75 AVMs were classified according to the Spetzler-Martin grading system; 21, 23, 28, 2, and 1 AVM were Grade I, II, III, IV, V, and VI, respectively.Results: The overall actuarial rate of obliteration was 43% (95% confidence interval [CI], 30-56%) at 3 years, 72% (95% CI, 58-86%) at 5 years, and 78% (95% CI, 63-93%) at 6 years. The actuarial obliteration rate at 5 years was 79% for the 42 AVMs 2 cm. The 5- and 6-year actuarial obliteration rate was 61% (95% Cl, 39-83%) and 71% (95% CI, 47-95%), respectively, after HSRT and 81% (95% CI, 66-96%) and 81% (95% CI, 66-96%), respectively, after SRS; the difference was not statistically significant. Radiation-induced necrosis was observed in 4 subjects in the SRS group and 1 subject in the HSRT group. Cyst formation occurred in 3 patients in the SRS group and no patient in the HSRT group. A permanent symptomatic complication was observed in 3 cases (4.2%), and 1 of the 3 was fatal. All 3 patients were in the SRS group. The annual intracranial hemorrhage rate was 5.5-5.6% for all patients.Conclusion: Our treatment policy using SRS and HSRT was as effective as the policy involving SRS alone. The HSRT schedule was suggested to have a lower frequency of radiation necrosis and cyst formation than the high-dose SRS schedule. The benefit of HSRT compared with lower dose SRS has not yet been determined. (C) 2004 Elsevier Inc.