Contrast media-assisted in-treatment cone beam CT during single-isocentre volumetric-modulated arc therapy for multiple brain metastases: a case study.
Contrast media-assisted in-treatment cone beam CT during single-isocentre volumetric-modulated arc therapy for multiple brain metastases: a case study.
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多发性脑转移瘤单等中心体积调制弧形治疗期间对比剂辅助治疗中锥形束 CT：案例研究。
DOI：
10.1016/j.wneu.2016.10.137
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发表时间：
2016
期刊：
影响因子：
0.6
通讯作者：
Nakagawa K
中科院分区：
文献类型：
--
作者：
Nomoto AK;Takahashi W (Corresponding Author);Yamashita H;Haga A;Yoda K;Nakagawa K
小脑动静脉畸形（C-AVM）由于其侵袭性的自然史而耐受性差。本研究的目的是描绘长期的结果伽玛刀立体定向放射外科（GKRS）C-AVM。MethodsThe结果45例患者接受GKRS C-AVM在我们的机构进行了回顾性分析。无事件生存率被定义为从任何神经功能缺损所造成的AVM或不良现象从treatment.ResultsThe中位年龄和随访时间分别为41年（范围，6-77年）和120个月（范围，5-291个月），分别。中位体积和Pollock-Flickinger放射外科AVM评分分别为1.3 cm 3（范围，0.1-8.3 cm 3）和1.26（范围，0.5-2.06）。3年、5年和6年时的精算闭塞率分别为46%、75%和90%。多因素分析显示，最大直径≤15 mm（P= 0.021）和边缘剂量>20戈伊（P= 0.0008）与较好的闭塞相关。4例患者发生治疗后出血，闭塞前后的年出血率分别为1.9%和0.30%。1例患者因出血死亡，而其他3例患者自行恢复。8例（16%）证实了灶周水肿;然而，未观察到症状性水肿。总体而言，在4例患者中观察到神经功能恶化; 3例是因为治疗后出血，1例是因为治疗前血管造影。无事件生存率分别为96%，93%和93%，在4年，10年和15年，respectives.ConclusionsGKRS是一个合理的干预C-AVM。症状并发症罕见，长期结果良好。
ObjectiveCerebellar arteriovenous malformation (C-AVM) is poorly tolerated because of its aggressive natural history. The aim of this study was to delineate long-term outcomes of Gamma Knife stereotactic radiosurgery (GKRS) for C-AVM.MethodsThe outcomes of 45 patients who underwent GKRS for C-AVMs at our institution were retrospectively analyzed. Event-free survival was defined as free from any neurologic deficits caused by AVMs or adverse phenomena from the treatment.ResultsThe median age and follow-up were 41 years (range, 6–77 years) and 120 months (range, 5–291 months), respectively. The median volume and Pollock-Flickinger radiosurgical AVM score were 1.3 cm3(range, 0.1–8.3 cm3) and 1.26 (range, 0.5–2.06), respectively. Actuarial obliteration rates were 46%, 75%, and 90% at 3, 5, and 6 years, respectively. Multivariate analysis showed that the maximal diameter ≤15 mm (P= 0.021) and margin dose >20 Gy (P= 0.0008) were significantly associated with better obliteration. Four patients experienced posttreatment hemorrhages, and annual hemorrhage rates were 1.9% and 0.30% before and after obliteration, respectively. One patient died because of hemorrhage, whereas the other 3 patients spontaneously recovered. Perifocal edema was confirmed in 8 (16%); however, no symptomatic edema was observed. Overall, neurologic deteriorations were noted in 4 patients; 3 were because of posttreatment hemorrhage, and 1 was because of pretreatment angiography. The event-free survival rates were 96%, 93%, and 93% at 4, 10, and 15 years, respectively.ConclusionsGKRS is a reasonable intervention for C-AVMs. Symptomatic complications are rare, and the long-term outcomes are favorable.