An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration
An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration
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DOI：
10.1016/s0167-8140(02)00103-2
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发表时间：
2002-06-01
影响因子：
5.7
通讯作者：
Lunsford, LD
中科院分区：
文献类型：
--
作者：
Flickinger, JC;Kondziolka, D;Lunsford, LD
目的：本研究的目的是更好地了解动静脉畸形 (AVM) 放射外科手术后的闭塞率。方法和材料：我们研究了 351 名动静脉畸形 (AVM) 患者接受伽玛刀放射外科手术后的闭塞情况，并进行了 3-11 年的随访影像学检查。中位边缘剂量为 20 Gy（范围：12-30），中位治疗体积为 5.7 cm(3)（范围：0.26-24）。 250 例 AVM 中仅采用立体定向靶向治疗，101 例 AVM 中采用附加磁共振 (MR) 成像。 结果：我们记录了 193/264 (73%) AVM 中通过血管造影实现闭塞，75/87 (86%) AVM 中仅通过 MR 实现了 75% 的校正闭塞率。我们发现，18% 的栓塞患者和 5% 的非栓塞患者存在持续性病灶外病灶（P = 6.006）。多变量分析将现场消除与边际剂量 (P < 0.0001) 和性别 (P ≤ 0.026，但总体消除 P = 0.19) 相关。构建了总体消除的数学剂量反应模型，以生成 AVM 消除的剂量反应曲线，最大总体消除率为 88%，最小改善超过 25 Gy。我们无法将 AVM 消除的 α/β 值定义为具有统计显着性的水平。结论：放射外科治疗的 AVM 消除率取决于剂量反应曲线所给予的边际剂量，最大可达约 88%。剂量反应平台反映了目标定义的问题，而先前的栓塞使目标定义变得更加困难。 (C) 2002 Elsevier Science Ireland Ltd. 保留所有权利。
Purpose: The aim of this study was to better understand arteriovenous malformation (AVM) obliteration rates after radiosurgery.Methods and materials: We studied obliteration after Gamma knife radiosurgery in 351 AVM patients with 3-11 years of follow-up imaging. The median marginal dose was 20 Gy (range: 12-30) and median treatment volume was 5.7 cm(3) (range: 0.26-24). Stereotactic targeting was with angiography alone in 250 AVMs, and additional magnetic resonance (MR) imaging in 101 AVMs.Results: We documented obliteration by angiography in 193/264 (73%) AVM, and by MR alone in 75/87 (86%) AVM for a 75% corrected obliteration rate. We identified persistent out-of-field nidus in 18% of embolized vs. 5% of non-embolized patients, (P = 6.006). Multivariate analysis correlated in-field obliteration with marginal dose (P < 0.0001) and sex (P ≤ 0.026, but not for overall obliteration P = 0.19). A mathematical dose-response model for overall obliteration was constructed to generate a dose-response curve for AVM obliteration with a maximum overall obliteration rate of 88% and minimal improvement above 25 Gy. We could not define the value of α/β for AVM obliteration to a level of statistical significance.Conclusion: The rate of AVM obliteration from radiosurgery depends on the marginal dose administered with a dose-response curve that reaches a maximum of approximately 88%. The dose-response plateau reflects problems with target definition which is made more difficult by prior embolization. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.