Zabel-du Bois Angelika, Milker-Zabel Stefanie, Huber Peter, Schlegel Wolfgang, Debus Jürgen
Department of Radiooncology, University of Heidelberg, Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2006 Mar 15;64(4):1049-54. doi: 10.1016/j.ijrobp.2005.09.021. Epub 2006 Jan 10.
We investigate retrospectively clinical outcome after radiosurgery (RS) or hypofractionated stereotactic radiotherapy (HSRT) in patients with large cerebral arteriovenous malformations (AVMs).
This analysis is based on 48 patients with cerebral AVM greater than 4 cm treated with HSRT or RS at our institution. Fifteen patients received HSRT, with 26 Gy median total dose in 4 to 5 fractions, and 33 patients received RS with 17 Gy median total dose in 4 to 5 fractions. Median target volume was 27 cc in HSRT and 7 cc in RS; median maximum diameter was 6 cm and 5 cm, respectively. Seventeen patients experienced intracranial hemorrhage before treatment. Median follow-up was 2.6 years.
The 3-year and 4-year actuarial complete obliteration (CO) after HSRT was 17% and 33% and after RS was 47% and 60%, respectively. Actuarial CO was higher in AVMs less than 5 cm (66% vs. 37% after 4 years). Intracranial hemorrhage after HSRT occurred in 3 of 15 patients after 18 months median, and after RS in 7 of 33 patients after 17 months median. Bleeding risk was significantly higher in patients with prior hemorrhage (p < 0.04). Preexisting neurologic dysfunction improved/dissolved in 50% and remained stable in 45%.
Large AVMs need a long time period to obliterate and show a high bleeding risk. Multimodal treatment strategies are required to reduce treatment volume before radiotherapy.
我们回顾性研究了大脑大型动静脉畸形（AVM）患者接受放射外科治疗（RS）或大分割立体定向放射治疗（HSRT）后的临床结局。
本分析基于我院48例接受HSRT或RS治疗的大脑AVM大于4 cm的患者。15例患者接受HSRT，中位总剂量为26 Gy，分4至5次给予；33例患者接受RS，中位总剂量为17 Gy，分4至5次给予。HSRT组中位靶体积为27 cc，RS组为7 cc；中位最大直径分别为6 cm和5 cm。17例患者在治疗前发生过颅内出血。中位随访时间为2.6年。
HSRT后3年和4年的精算完全闭塞率（CO）分别为17%和33%，RS后分别为47%和60%。直径小于5 cm的AVM精算CO更高（4年后分别为66%和37%）。HSRT组15例患者中有3例在中位18个月后发生颅内出血，RS组33例患者中有7例在中位17个月后发生颅内出血。既往有出血史的患者出血风险显著更高（p < 0.04）。既往存在的神经功能障碍有50%改善/消失，45%保持稳定。
大型AVM需要较长时间才能闭塞，且出血风险较高。需要采用多模式治疗策略在放疗前缩小治疗体积。
