Flickinger J C, Pollock B E, Kondziolka D, Lunsford L D
Department of Radiation Oncology, University of Pittsburgh School of Medicine, PA 15213, USA.
Int J Radiat Oncol Biol Phys. 1996 Nov 1;36(4):873-9. doi: 10.1016/s0360-3016(96)00316-1.
Although radiosurgery is effective in obliterating the pathologic vessels of intracranial arteriovenous malformations (AVM), the relationships of both dose and volume to obliteration have not been well defined.
The results of radiosurgery in 197 AVM patients with 3-year angiographic follow-up were analyzed. Volume varied from 0.06-18 cc (median: 4.1 cc), and minimum target dose (Dmin) varied from 12.0-25.6 Gy (median: 20.0 Gy).
Follow-up angiography revealed complete AVM obliteration in 142 out of 197 patients (72%). The targeted AVM nidus failed to obliterate in 20 patients (10%), but in-field obliteration was complete in the remaining 35 patients (18%) discovered to have residual untargeted AVM nidus. Multivariate logistic regression analysis of in-field obliteration revealed a significant independent correlation with Dmin (p = 0.04), but not with volume or maximum dose. A sigmoid dose-response curve for in-field obliteration was constructed that significantly differed from the dose-volume-response relationships that would have been expected from overall obliteration data.
The success rate for in-field obliteration of AVM after radiosurgery depends on Dmin but does not appear to change appreciably with volume or maximum dose. Success rates for complete obliteration additionally are limited by problems defining the complete AVM nidus.
尽管放射外科手术在消除颅内动静脉畸形（AVM）的病理性血管方面有效，但剂量和体积与消除之间的关系尚未明确界定。
分析了197例接受放射外科手术且有3年血管造影随访结果的AVM患者。体积从0.06 - 18立方厘米不等（中位数：4.1立方厘米），最小靶剂量（Dmin）从12.0 - 25.6 Gy不等（中位数：20.0 Gy）。
随访血管造影显示，197例患者中有142例（72%）的AVM完全消除。20例患者（10%）的靶向AVM病灶未消除，但在其余35例发现有残留非靶向AVM病灶的患者中，病灶内消除是完全的（18%）。对病灶内消除进行多变量逻辑回归分析发现，与Dmin有显著独立相关性（p = 0.04），但与体积或最大剂量无关。构建了病灶内消除的S形剂量反应曲线，该曲线与根据总体消除数据预期的剂量 - 体积反应关系有显著差异。
放射外科手术后AVM病灶内消除的成功率取决于Dmin，但似乎不会随体积或最大剂量而明显变化。完全消除的成功率还受到定义完整AVM病灶问题的限制。
