Tseĭtlina M A, Kizhaev E V, Luchin E I, Agapov A V, Gaevskiĭ V N, Gulidov I A, Mitsyn G V, Molokanov A V, Sobolev D K, Shvidkiĭ S V, Shipulin K N
Zh Vopr Neirokhir Im N N Burdenko. 2013;77(4):43-50; discussion 50.
The proton beam radiosurgery was performed to 65 patients with brain AVM since December, 2001 till February, 2012, in Joint Institute for Nuclear Research, Dubna, Russia. We have analyzed data for 56 patients. The follow up time varied from 24 to 109 months. The volumes of brain AVMs varied from 0.92 to 82 cc. The mean isocenter dose was 24.61 +/- 0.12 Gy E. The edge of the target was included in 70-90% isodose. The proton beam surgery was splitted in two similar doses and delivered in two consecutive days in vast majority of patients. Ten patients were missed for follow up due to some reasons. The radiosurgery was resulted in full obliteration of AVM in 23 from remaining 46 (50%) patients. There was full obliteration in 46.6% of patients with volume of AVM 10-24.9 cc; and this rate is significantly more than for photon radiosurgery of same size brain AVM. The partial obliteration was obtained in 21 patients. Only one patients suffered hemorrhage from partially obliterated AVM. We could not see any effect in 2 patients. There were delayed radiation toxicity in 5 patients in 12 months after treatment: in 4 patients, these reactions were assessed as 2 according to RTOG scale and were dissipated in 1 month after commencement of corticosteroid treatment. There was radiation necrosis in one patient, and it was relieved in 12 months after several courses of dehydration and corticosteroid therapy. So, proton beam therapy is effective and safe modality for treatment of inoperable brain AVM, especially of middle- and large size.
2001年12月至2012年2月期间，俄罗斯杜布纳联合核研究所对65例脑动静脉畸形（AVM）患者实施了质子束放射外科治疗。我们分析了56例患者的数据。随访时间为24至109个月。脑AVM的体积为0.92至82立方厘米。平均等中心剂量为24.61±0.12 Gy E。靶区边缘包含在70%-90%等剂量线内。绝大多数患者的质子束治疗分为两个相似剂量，连续两天给予。由于某些原因，10例患者失访。在其余46例患者中，有23例（50%）的放射外科治疗导致AVM完全闭塞。AVM体积为10-24.9立方厘米的患者中，完全闭塞率为46.6%；该比率明显高于相同大小脑AVM的光子放射外科治疗。21例患者出现部分闭塞。只有1例患者因部分闭塞的AVM发生出血。2例患者未见任何效果。5例患者在治疗后12个月出现延迟性放射毒性：4例患者根据RTOG标准评估为2级反应，在开始使用皮质类固醇治疗1个月后消退。1例患者出现放射性坏死，在经过几个疗程的脱水和皮质类固醇治疗后12个月缓解。因此，质子束治疗是治疗无法手术的脑AVM，尤其是中大型脑AVM的有效且安全的方式。
