Zabel-du Bois Angelika, Milker-Zabel Stefanie, Huber Peter, Schlegel Wolfgang, Debus Jürgen
Department of Radiotherapy, German Cancer Research Center, and Department of RadioOncology, University of Heidelberg, Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1206-11. doi: 10.1016/j.ijrobp.2006.01.041. Epub 2006 May 6.
To evaluate retrospectively clinical outcome and obliteration rates after linac-based radiosurgery (RS) in children with cerebral arteriovenous malformations (AVM).
Between 1996 and 2002, 22 children with cerebral AVM were treated at our institution. Mean age at treatment was 11.8 years (range, 4.4-16.4 years). Classification according to Spetzler-Martin was 1 child grade I (4%), 7 grade II (32%), 12 grade III (56%), 1 grade IV (4%), and 1 grade V (4%). Median single dose was 18 Gy/80%-isodose. Median AVM volume was 4.2 mL (range, 0.4-26.5 mL). Median RS-based AVM-score was 1.07 (range, 0.61-3.55). Fifty-nine percent of children experienced intracranial hemorrhage before RS. Median follow-up was 3.1 years (range, 1.7-7.3 years).
Actuarial complete obliteration rate (CO) was 54% after 3 years and 65% after 4 years, respectively. Median time interval to CO was 27.1 months. Intracranial hemorrhage after RS was seen in five children after median 13.9 months. Annual bleeding risk was 9.1% after 1 year and 13.6% after 2 years. Maximum diameter>or=3 cm and AVM-volume>or=6 mL were significant predictors for intracranial hemorrhage. Neurologic deficits were improved/completely dissolved in 58% of children and remained stable in 42%. No new onset of neurologic dysfunction was seen after RS.
RS is safe and effective in pediatric cerebral AVM with high obliteration rates. Size and volume of AVM are significant predictors for intracranial bleeding. The same treatment guidelines as in adults should be applied. Careful long-term follow-up observation is required after RS from long life expectation.
回顾性评估基于直线加速器的放射外科治疗（RS）对儿童脑动静脉畸形（AVM）的临床疗效及闭塞率。
1996年至2002年间，我院共治疗22例儿童脑AVM。治疗时的平均年龄为11.8岁（范围4.4 - 16.4岁）。根据斯佩茨勒 - 马丁分级，I级1例（4%），II级7例（32%），III级12例（56%），IV级1例（4%），V级1例（4%）。单次剂量中位数为18 Gy/80%等剂量线。AVM体积中位数为4.2 mL（范围0.4 - 26.5 mL）。基于RS的AVM评分中位数为1.07（范围0.61 - 3.55）。59%的儿童在RS治疗前发生过颅内出血。中位随访时间为3.1年（范围1.7 - 7.3年）。
3年时的精算完全闭塞率（CO）分别为54%，4年时为65%。达到CO的中位时间间隔为27.1个月。RS治疗后，5例儿童在中位时间13.9个月后出现颅内出血。1年后的年出血风险为9.1%，2年后为13.6%。最大直径≥3 cm和AVM体积≥6 mL是颅内出血的显著预测因素。58%的儿童神经功能缺损得到改善/完全消失，42%保持稳定。RS治疗后未出现新的神经功能障碍。
RS治疗小儿脑AVM安全有效，闭塞率高。AVM的大小和体积是颅内出血的重要预测因素。应采用与成人相同的治疗指南。鉴于预期寿命长，RS治疗后需要进行仔细的长期随访观察。
