Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA.
Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA.
World Neurosurg. 2019 Jun;126:e1456-e1467. doi: 10.1016/j.wneu.2019.03.119. Epub 2019 Mar 20.
Brain arteriovenous malformations (AVMs) are pathologic tangles of intracerebral vessels. The treatment of AVMs aims to reduce the risk of devastating intracranial hemorrhage (ICH). Hypofractionated stereotactic radiotherapy (HSRT) can be used to treat large lesions and reduce the risk of radiation toxicity to the surrounding structures. We analyzed the data from our institutional experience of the past 15 years in treating large AVMs with both 5- and 6-fraction HSRT and evaluated the pretreatment characteristics that are most predictive of the radiographic response.
We included 37 patients and 42 treatments of intracranial AVMs measuring >3 cm in their largest dimension. Data were collected retrospectively by reviewing the electronic health records. The AVM volume was measured before HSRT and at the most recent follow-up appointment. Symptomatic outcomes, including treatment-related inflammation, were measured and defined categorically.
Complete obliteration was achieved in 11.9% of the patients. The mean AVM volume had decreased significantly after HSRT (P = 8.7e-8). The percentage of volume reduction differed significantly between patients receiving 30-Gy fractions, (∂V = -48.7%) and those receiving 25-Gy fractions (∂V = -29.1%; P = 0.035). Patients with partial or complete obliteration were more likely to have received a total dose of 30 Gy rather than 25 Gy (P = 0.056) and showed a trend toward being treatment naive (P = 0.053).
HSRT can be used as a method to manage large AVMs, with obliteration in some cases and sufficient volume reduction in most others for adjuvant treatment with other modalities. The 30-Gy total dose was generally superior to 25 Gy in achieving obliteration or volume reduction. Further studies focused on longer follow-up periods are warranted.
脑动静脉畸形（AVM）是颅内血管的病理性缠绕。AVM 的治疗旨在降低毁灭性颅内出血（ICH）的风险。低分割立体定向放射治疗（HSRT）可用于治疗大病变并降低周围结构辐射毒性的风险。我们分析了过去 15 年我们机构使用 5 分法和 6 分法 HSRT 治疗大型 AVM 的经验数据，并评估了预测放射反应的最具预测性的预处理特征。
我们纳入了 37 名患者和 42 次颅内 AVM 治疗，其最大尺寸大于 3cm。数据通过回顾电子病历进行回顾性收集。在 HSRT 之前和最近的随访预约时测量 AVM 体积。测量并分类了症状性结果，包括与治疗相关的炎症。
11.9%的患者达到完全闭塞。HSRT 后 AVM 体积明显减少（P=8.7e-8）。接受 30-Gy 剂量的患者体积减少百分比（∂V=-48.7%）与接受 25-Gy 剂量的患者（∂V=-29.1%；P=0.035）有显著差异。部分或完全闭塞的患者更有可能接受 30 Gy 总剂量而不是 25 Gy（P=0.056），并且有治疗初治（P=0.053）的趋势。
HSRT 可用于治疗大型 AVM，某些情况下可达到闭塞，大多数情况下可达到足够的体积减少，以便用其他方法进行辅助治疗。30 Gy 总剂量在达到闭塞或体积减少方面通常优于 25 Gy。需要进一步研究关注更长的随访时间。
