Department of Radiation Oncology and Radiosurgery, Okmeydani Training And Research Hospital, Istanbul, Turkey.
Department of Neurosurgery, Okmeydani Training And Research Hospital, Istanbul, Turkey.
J Radiat Res. 2023 Jan 20;64(1):133-141. doi: 10.1093/jrr/rrac056.
In this study, the dose schedule efficacy, safety and late adverse effects of stereotactic radiosurgery (SRS) were evaluated for patients with symptomatic cavernomas who were not eligible for surgery and treated with SRS. Between January 2013 and December 2018, 53 patients with cavernomas were treated using SRS with the CyberKnife® system. Patients' diseases were deeply located or were in subcortical functional brain regions. In addition to bleeding, 23 (43.4%) patients had epilepsy, 12 (22.6%) had neurologic symptoms and 16 patients (30.2%) had severe headaches. The median volume was 741 (range, 421-1351) mm3, and the median dose was 15 (range, 14-16) Gy in one fraction. After treatment, six (50%) of 12 patients with neurologic deficits still had deficits. Rebleeding after treatment developed in only two (3.8%) patients. The drug was completely stopped in 14 (60.9%) out of 23 patients who received epilepsy treatment, and the dose of levetiracetam decreased from 2000 mg to 1000 mg in four (17.3%) of nine patients. Radiologically, complete response (CR) was observed in 13 (24.5%) patients, and partial responses (PR) were observed in 32 (60.2%) patients. Clinical response of CR was observed in 30 (56.6%) patients, PR was observed in 16 (30.2%), stable disease (SD) was observed in three (5.7%) and four (7.5%) patients progressed. In conclusion, SRS applied in the appropriate dose schedule may be an effective and reliable method in terms of symptom control and prevention of rebleeding, especially in patients with inoperable cavernomas.
在这项研究中，对不符合手术条件且接受立体定向放射外科（SRS）治疗的有症状海绵状血管畸形患者进行了剂量方案疗效、安全性和晚期不良反应评估。2013 年 1 月至 2018 年 12 月，53 例海绵状血管畸形患者采用 CyberKnife®系统进行 SRS 治疗。患者的疾病位于深部或皮质下功能脑区。除出血外，23 例（43.4%）患者患有癫痫，12 例（22.6%）患者有神经系统症状，16 例（30.2%）患者有严重头痛。中位体积为 741（范围，421-1351）mm3，单次分割剂量为 15（范围，14-16）Gy。治疗后，12 例有神经系统缺损的患者中仍有 6 例（50%）有缺损。仅 2 例（3.8%）患者在治疗后出现再出血。23 例接受癫痫治疗的患者中有 14 例（60.9%）完全停止使用药物，9 例患者中的 4 例（17.3%）将左乙拉西坦的剂量从 2000mg 减少至 1000mg。影像学上，13 例（24.5%）患者完全缓解（CR），32 例（60.2%）患者部分缓解（PR）。30 例（56.6%）患者临床缓解 CR，16 例（30.2%）患者 PR，3 例（5.7%）患者病情稳定（SD），4 例（7.5%）患者进展。总之，SRS 在适当的剂量方案下应用可能是一种有效的、可靠的方法，特别是对于无法手术的海绵状血管畸形患者，可控制症状并预防再出血。
