Departments of Neurosurgery and Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.
Departments of Neurosurgery and Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.
Int J Radiat Oncol Biol Phys. 2014 Jul 1;89(3):576-83. doi: 10.1016/j.ijrobp.2014.03.017. Epub 2014 May 3.
Although radiosurgery is an accepted treatment method for intracranial arteriovenous malformations (AVMs), its long-term therapeutic effects have not been sufficiently evaluated, and many reports of long-term observations are from gamma-knife facilities. Furthermore, there are few reported results of treatment using only linear accelerator (LINAC)-based radiosurgery (LBRS).
Over a period of more than 12 years, we followed the long-term results of LBRS treatment performed in 51 AVM patients.
The actuarial obliteration rates, after a single radiosurgery session, at 3, 5, 10, and 15 years were 46.9%, 54.0%, 64.4%, and 68.0%, respectively; when subsequent radiosurgeries were included, the rates were 46.9%, 61.3%, 74.2%, and 90.3%, respectively. Obliteration rates were significantly related to target volumes ≥4 cm(3), marginal doses ≥12 Gy, Spetzler-Martin grades (1 vs other), and AVM scores ≥1.5; multivariate analyses revealed a significant difference for target volumes ≥4 cm(3). The postprocedural actuarial symptomatic radiation injury rates, after a single radiation surgery session, at 5, 10, and 15 years were 12.3%, 16.8%, and 19.1%, respectively. Volumes ≥4 cm(3), location (lobular or other), AVM scores ≥1.5, and the number of radiosurgery were related to radiation injury incidence; multivariate analyses revealed significant differences associated with volumes ≥4 cm(3) and location (lobular or other).
Positive results can be obtained with LBRS when performed with a target volume ≤4 cm(3), an AVM score ≤1.5, and ≥12 Gy radiation. Bleeding and radiation injuries may appear even 10 years after treatment, necessitating long-term observation.
尽管放射外科手术是治疗颅内动静脉畸形（AVM）的一种公认方法，但它的长期治疗效果尚未得到充分评估，并且许多长期观察报告来自伽玛刀设备。此外，使用仅基于线性加速器（LINAC）的放射外科手术（LBRS）治疗的报道结果很少。
在超过 12 年的时间里，我们对 51 例 AVM 患者接受 LBRS 治疗的长期结果进行了随访。
单次放射外科手术后，分别在 3、5、10 和 15 年的实际闭塞率为 46.9%、54.0%、64.4%和 68.0%；当包括后续放射外科手术时，闭塞率分别为 46.9%、61.3%、74.2%和 90.3%。闭塞率与靶体积≥4cm³、边缘剂量≥12Gy、Spetzler-Martin 分级（1 级与其他）和 AVM 评分≥1.5 显著相关；多变量分析显示靶体积≥4cm³有显著差异。单次放射外科手术后，分别在 5、10 和 15 年的实际症状性放射性损伤发生率为 12.3%、16.8%和 19.1%。靶体积≥4cm³、位置（叶状或其他）、AVM 评分≥1.5 和放射外科手术次数与放射性损伤发生率相关；多变量分析显示靶体积≥4cm³和位置（叶状或其他）与显著差异相关。
当靶体积≤4cm³、AVM 评分≤1.5 和≥12Gy 放射时，LBRS 可以获得阳性结果。即使在治疗后 10 年，也可能出现出血和放射性损伤，需要长期观察。
