Fabrikant J I, Levy R P, Steinberg G K, Silverberg G D, Frankel K A, Phillips M H, Lyman J T
Donner Laboratory, University of California, Berkeley.
Stereotact Funct Neurosurg. 1991;57(1-2):50-63. doi: 10.1159/000099555.
We have treated over 400 patients with symptomatic inoperable intracranial arteriovenous malformations (AVMs) with stereotactic heavy-charged-particle Bragg peak radiosurgery at the University of California at Berkeley in a collaborative program with Stanford University Medical Center and the University of California Medical Center, San Francisco. A long-term dose-searching clinical trial protocol has been developed and we have followed more than 250 patients for more than 2 years. Initially, radiation doses ranged from 45 to 35 GyE, and now doses of 25, 20, 15 and, under special circumstances, 10 GyE, depending on a number of factors, are being evaluated. The characteristics of charged-particle beams provide a relatively homogeneous dose distribution with the 90% isodose contour to the periphery of the lesion. When the entire arterial phase of the AVM core is included in the treatment field, the rates for complete obliteration 3 years after treatment are: 90-95% for volumes less than or equal to 4 cm3; 90-95% for volumes greater than 4 and less than or equal to 14 cm3; and 60-70% for volumes greater than 14 cm3. The total obliteration rate for all volumes up to 70 cm3 is approximately 80-85%. For complete radiation-induced obliteration there is a relationship of dose and volume primarily, and location secondarily. Results on relationships between dose, AVM obliteration, and complications and sequelae of the radiosurgical procedure are presented and discussed.
在与斯坦福大学医学中心和旧金山加利福尼亚大学医学中心合作开展的项目中，我们在加利福尼亚大学伯克利分校采用立体定向重带电粒子布拉格峰放射外科手术，治疗了400多名有症状的无法手术切除的颅内动静脉畸形（AVM）患者。我们制定了一项长期剂量探索性临床试验方案，已经对250多名患者进行了两年多的随访。最初，放射剂量范围为45至35 GyE，现在正在评估根据多种因素而定的25、20、15 GyE，在特殊情况下还有10 GyE的剂量。带电粒子束的特性可提供相对均匀的剂量分布，90%等剂量线围绕病变周边。当AVM核心的整个动脉期都包含在治疗野内时，治疗后3年的完全闭塞率为：体积小于或等于4 cm³的，闭塞率为90 - 95%；体积大于4 cm³且小于或等于14 cm³的，闭塞率为90 - 95%；体积大于14 cm³的，闭塞率为60 - 70%。所有体积达70 cm³的总体闭塞率约为80 - 85%。对于放射诱导的完全闭塞，主要与剂量和体积有关，其次与位置有关。本文展示并讨论了剂量、AVM闭塞以及放射外科手术并发症和后遗症之间关系的结果。
