Schlienger M, Merienne L, Lefkopoulos D, Touboul E, Laurent A, Missir O, Hancilar T, Lefkopoulos A
Service de radiothérapie B, hôpital Tenon, Paris, France.
Bull Cancer Radiother. 1994;81(2):99-109.
During 1990 we treated 49 cases of arterio-veinous malformations (AVMs) using radiosurgery. We employed 15 MV X-Ray minibeams of a Saturne 43 Linac, eight additional collimators, 6-20 mm, the O Betti armchair and the Talairach stereotactic frame. Irradiation consisted of delivering 25 Gy at the periphery of the nidus corresponding to the 60-70% peripheral isodose range. We used the "Associated Target Methodology" and the three-dimensional treatment planning system Artemis-3D, both of which have been developed in our radiotherapy department. In December 1992, 44 out of 49 patients who had been treated were available for analysis with a 2-3-year follow-up. The overall obliteration rate was 33/44 (75%). According to the number of isocenters the obliteration rate was: 22/26 (85%) for one isocenter. In 18 multi-isocenters irradiation cases overall obliteration rate was 11/18 (61%). Two isocenters were used in nine of these 18 cases, the obliteration rate was 6/9; while when three isocenters were used it was 2/4 and in five cases of four isocenters irradiation the obliteration rate was 3/5. Obliteration rate for lesions < or = 4200 mm3 was 31/37 (84%). For greater volumes (5500 mm3 to 19000 mm3; median 9200 mm3) the obliteration rate was 2/7 whereas three others were partially (75 to 90%) obliterated and two remained inchanged. Before radiosurgery 21 cases received other treatment (mostly embolizations), the obliteration rate in this group was 15/21 (71.5%) while in previously untreated AVMs it was 18/23 (78%). A control arteriography was performed between 6 to 18 months after radiosurgery in 44 patients; three others refused the arteriography but are alive and well; two others had palliative irradiation, one of whom is dead. Out of 28 AVMs checked between 6 to 12 months 17/28 were obliterated (61%). In four cases, epilepsy was the first symptom; one has not suffered a further crisis whereas three others experienced a decrease in the number of crises. Two patients had recurrence of bleeding four and six months after irradiation (recurrence rate 2/44 = 5%). There were no lasting neurological consequences.
1990年期间，我们使用放射外科治疗了49例动静脉畸形（AVM）。我们采用了一台Saturn 43直线加速器的15 MV X射线微束、八个额外的6 - 20毫米准直器、奥贝蒂扶手椅和塔莱拉赫立体定向框架。照射是在病灶边缘给予25 Gy，对应60 - 70%的周边等剂量范围。我们使用了“联合靶区方法”和三维治疗计划系统Artemis - 3D，这两者均由我们放疗科研发。1992年12月，49例接受治疗的患者中有44例可进行分析，随访时间为2 - 3年。总体闭塞率为33/44（75%）。根据等中心数量，闭塞率如下：单等中心为22/26（85%）。在18例多等中心照射病例中，总体闭塞率为11/18（61%）。这18例中有9例使用了两个等中心，闭塞率为6/9；使用三个等中心时为2/4，在5例使用四个等中心照射的病例中，闭塞率为3/5。体积≤4200立方毫米的病灶闭塞率为31/37（84%）。对于更大体积（5500立方毫米至19000立方毫米；中位数9200立方毫米），闭塞率为2/7，另外三例部分（75%至90%）闭塞，两例保持不变。在接受放射外科治疗前，21例患者接受过其他治疗（大多为栓塞术），该组闭塞率为15/21（71.5%），而在先前未治疗的AVM中，闭塞率为18/23（78%）。44例患者在放射外科治疗后6至18个月进行了对照血管造影；另外三例拒绝血管造影，但存活且情况良好；还有两例接受了姑息性照射，其中一例死亡。在28例6至12个月时检查的AVM中，17/28闭塞（61%）。4例患者中，癫痫是首发症状；1例未再发作，另外3例发作次数减少。2例患者在照射后4个月和6个月出现出血复发（复发率2/44 = 5%）。无持久的神经学后果。
