Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
J Clin Neurosci. 2020 Dec;82(Pt B):241-246. doi: 10.1016/j.jocn.2020.10.057. Epub 2020 Nov 24.
To evaluate long term treatment efficacy and complications of hypofractionated stereotactic radiosurgery (hfSRS) and identify factors that predict outcomes.
A retrospective review was conducted on 34 consecutive patients who received hfSRS from 2008 to 2017. Demographic, clinical, angio-architectural characteristics, and radiosurgery data were extracted from the Clinical Data Analysis and Reporting System and our unit's iPlan (BrainLAB, Munich) system. Data was analysed using SPSS.
5-year obliteration rate was 39.1%. Most patients (n = 29, 85.3%) recovered well with GOS of 4-5. 26.9% (n = 9) patients have at least one post-radiosurgery complication including hemorrhage, neurological deficits, radionecrosis. Neurological morbidity and mortality was 17.6% (n = 6). A higher modified radiosurgery arteriovenous malformation score (mRBAS) is associated with a lower 5-year obliteration rate (Rho = -0.486, p = 0.025). None of the bAVM were obliterated once mRBAS exceeds 5.35. As expected, a larger 20-Gy volume outside lesion is associated with more complications and poorer GOS. Interestingly, irradiated drainage vein volume indexed to AVM volume (iiDVV) correlates with increased risks of post-hfSRS haemorrhage (Rho = 0.472, p = 0.031) and reduced event-free survival (Rho = -0.472, p = 0.031). Once iiDVV exceeds 20%, a high rebleeding rate after hfSRS is anticipated (AUC under ROC 0.889).
Hypofractionated stereotactic radiosurgery is an alternative radiosurgery treatment for bAVM unsuitable for single-fraction SRS. mRBAS predicts obliteration rate and morbidity in hfSRS. Index irradiated drainage vein volume (iiDVV) is associated with event-free survival and rebleeding and should be minimized if feasible.
评估低分割立体定向放射外科治疗（hfSRS）的长期疗效和并发症，并确定预测结果的因素。
对 2008 年至 2017 年间接受 hfSRS 的 34 例连续患者进行回顾性分析。从临床数据分析和报告系统和我们单位的 iPlan（BrainLAB，慕尼黑）系统中提取人口统计学、临床、血管生成结构特征和放射外科数据。使用 SPSS 进行数据分析。
5 年闭塞率为 39.1%。大多数患者（n=29，85.3%）恢复良好，GOS 为 4-5。9 例（26.9%）患者至少有 1 种放射外科后并发症，包括出血、神经功能缺损、放射性坏死。神经发病率和死亡率为 17.6%（n=6）。较高的改良放射外科动静脉畸形评分（mRBAS）与较低的 5 年闭塞率相关（Rho=-0.486，p=0.025）。mRBAS 一旦超过 5.35，就没有 bAVM 完全闭塞。正如预期的那样，病变外 20-Gy 体积越大，并发症越多，GOS 越差。有趣的是，受照引流静脉体积与动静脉畸形体积的比值（iiDVV）与 hfSRS 后出血风险增加（Rho=0.472，p=0.031）和无事件生存率降低相关（Rho=-0.472，p=0.031）。一旦 iiDVV 超过 20%，hfSRS 后再出血率预计会很高（ROC 下 AUC 为 0.889）。
低分割立体定向放射外科是不适合单次分割 SRS 的 bAVM 的替代放射外科治疗方法。mRBAS 预测 hfSRS 的闭塞率和发病率。受照引流静脉体积指数（iiDVV）与无事件生存率和再出血相关，如果可行，应尽量减小。
