Ma Lijun, Fogh Shannon, Gupta Nalin, Hwang Andrew, Pinnaduwage Dilini, Nakamura Jean, Barani Igor, McDermott Michael, Sneed Penny K, Larson David A, Sahgal Arjun
Department of Radiation Oncology, University of California, San Francisco, California, USA.
Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
J Radiosurg SBRT. 2012;2(1):11-17.
A technique for delivering high-precision volume-staged stereotactic radiosurgery has been developed with Leksell Gamma Knife Perfexion for treating large arteriorvenous malformations (AVMs). The technique employs a hybrid method of combining landmark registration and voxel-based 3D image registration to enable multiple staged partial-volume treatments that accommodate repeated stereotactic frame placements. The technique was clinically implemented at our institution and the results were analyzed for a series (n=14) of large AVM cases treated since 2007. Overall, an averaged 0.34±0.09 mm in matching procedural accuracy versus standard single-fraction radiosurgery was found for these treatments. Such a result is a factor of 3-4 times lower than those previously reported, and it approaches the physical accuracy of the latest Leksell Gamma Knife Perfexion system. In conclusion, volume-staged radiosurgery has been demonstrated to be deliverable with the same level of accuracy as standard single-fraction radiosurgery.
一种用于实施高精度体积分期立体定向放射外科手术的技术已通过Leksell伽玛刀Perfexion系统得以开发，用于治疗大型动静脉畸形（AVM）。该技术采用了一种将标志物配准和基于体素的三维图像配准相结合的混合方法，以实现多次分期的部分体积治疗，从而适应重复的立体定向框架放置。该技术已在我们机构临床应用，并对自2007年以来治疗的一系列（n = 14）大型AVM病例的结果进行了分析。总体而言，这些治疗与标准单次分割放射外科手术相比，在程序匹配精度上平均为0.34±0.09毫米。这一结果比之前报道的低3至4倍，且接近最新Leksell伽玛刀Perfexion系统的物理精度。总之，已证明体积分期放射外科手术能够以与标准单次分割放射外科手术相同的精度实施。
