Bollet Marc A, Anxionnat René, Buchheit Isabelle, Bey Pierre, Cordebar Alexandre, Jay Nicolas, Desandes Emmanuel, Marchal Christian, Lapeyre Michel, Aletti Pierre, Picard Luc
Department of Radiotherapy, Centre Alexis Vautrin Cancer Center, Vandoeuvre-lès-Nancy, France.
Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1353-63. doi: 10.1016/j.ijrobp.2003.09.005.
To report the results of arc-therapy radiosurgery for cerebral arteriovenous malformation (AVM) and to compare the adverse event rate with the rate expected from the natural history.
We performed a retrospective study of our 118 first patients with a mean follow-up of 46 months (range, 5-105 months). The AVMs had features indicating a poor prognosis at initial presentation and had already been treated by previous embolizations in 88% of patients. The mean volume of the targets was 7.4 cm3 (range, 0.3-28.3 cm3). The mean minimal and maximal dose was 17.7 Gy (range, 10-25 Gy) and 24.5 Gy (range, 17-36 Gy), respectively.
The crude and 5-year actuarial rate of cure (total obstruction of the AVM shunt at angiography) was 54% (60 of 112) and 77%, respectively. The only independent prognostic factor of cure was the AVM volume (crude cure rate 67% for <7 cm3 vs. 35% for > or =7 cm3; p = 0.001). No patient died. Transient and permanent complications and hemorrhage occurred in 5%, 1.7%, and 6% of patients, respectively. The annual risk of an adverse event (hemorrhage or complication) was 3.9%.
The results of our series showed that radiosurgery, performed alone or after prior shrinkage of the AVM by embolization, is both effective and well tolerated, with a rate of adverse events comparable to that expected from the natural history.
报告脑动静脉畸形（AVM）的弧形放疗放射外科治疗结果，并将不良事件发生率与自然病程预期发生率进行比较。
我们对118例首例患者进行了回顾性研究，平均随访46个月（范围5 - 105个月）。这些AVM在初次就诊时具有预后不良的特征，88%的患者此前已接受过栓塞治疗。靶区平均体积为7.4 cm³（范围0.3 - 28.3 cm³）。平均最小剂量和最大剂量分别为17.7 Gy（范围10 - 25 Gy）和24.5 Gy（范围17 - 36 Gy）。
粗略治愈率和5年精算治愈率（血管造影时AVM分流完全阻塞）分别为54%（112例中的60例）和77%。唯一独立的治愈预后因素是AVM体积（<7 cm³的粗略治愈率为67%，而≥7 cm³的为35%；p = 0.001）。无患者死亡。分别有5%、1.7%和6%的患者发生了短暂性和永久性并发症以及出血。不良事件（出血或并发症）的年风险为3.9%。
我们系列研究的结果表明，单独进行放射外科治疗或在AVM通过栓塞预先缩小后进行该治疗，都是有效且耐受性良好的，不良事件发生率与自然病程预期发生率相当。
