Does Advanced Age Affect the Outcomes of Stereotactic Radiosurgery for Cerebral Arteriovenous Malformation?
Does Advanced Age Affect the Outcomes of Stereotactic Radiosurgery for Cerebral Arteriovenous Malformation?
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DOI：
10.1016/j.wneu.2017.10.071
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Saito, Nobuhito
中科院分区：
文献类型：
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作者：
Hasegawa, Hirotaka;Hanakita, Shunya;Saito, Nobuhito
背景：立体定向放射外科（SRS）通常被认为是一种微创治疗方式。然而，关于SRS在老年人群中的有效性的明确证据仍然没有。方法：回顾、分析和比较我院1990年至2013年间561例因AVM接受SRS治疗的老年和非老年患者的预后。老年患者定义为SRS时年龄>= 60岁的患者。结果：老年队列55例；非老年组，506人。老年队列中位年龄为65岁，随访时间为91个月。精算湮没率在老年队列中为3年47%，4年70%，5年76%，在非老年队列中为3年57%，4年76%，5年83%。在老年队列中，srs后潜伏期出血率在出血性患者中为5.2%/年，在非出血性患者中为0%/年，6年无事件生存率（EFS）为93%，12年为89%。两组患者的病灶闭塞率、死亡率和EFS发生率无显著差异，而老年组患者的病灶周围水肿发生率明显较低（P = 0.021）。srs前和srs后的出血率在老年队列中略高，但无统计学意义。结论：SRS在老年和非老年患者中的治疗效果和结局相似。治疗相关的神经功能缺损是罕见的，并且可以预期更长时间的EFS。
BACKGROUND: Stereotactic radiosurgery (SRS) is generally considered a minimally invasive treatment modality. However, definitive evidence of the efficacy of SRS in the elderly population is still not available.METHODS: The outcomes of 561 elderly and nonelderly patients who underwent SRS for AVM at our institution between 1990 and 2013 were reviewed, analyzed, and compared. Elderly patients were defined as those age >= 60 years at the time of SRS.RESULTS: The elderly cohort comprised 55 patients; the nonelderly cohort, 506. In the elderly cohort, the median age was 65 years, and the duration of follow-up was 91 months. The actuarial obliteration rates were 47% at 3 years, 70% at 4 years, and 76% at 5 years in the elderly cohort, and 57% at 3 years, 76% at 4 years, and 83% at 5 years in the nonelderly cohort. In the elderly cohort, the hemorrhage rates during the post-SRS latent phase were 5.2%/year in patients with hemorrhagic onset and 0%/year in those with nonhemorrhagic onset, and event-free survival (EFS) was 93% at 6 years and 89% at 12 years. The obliteration rate, mortality, and EFS rate were not significantly different between the 2 cohorts, whereas the rate of perifocal edema was significantly lower (P = 0.021) in the elderly cohort. The pre-SRS and post-SRS hemorrhage rates were slightly higher in the elderly cohort, albeit without statistical significance.CONCLUSIONS: Therapeutic effects and outcomes of SRS are similar in elderly and nonelderly patients. Treatment-related neurologic deficits are rare, and longer EFS can be expected.