- 期刊
以立體定位放射手術治療腦動靜脈畸形：高雄長庚紀念醫院之初步結果
Treatment of Brain Arteriovenous Malformation (AVM) with Stereotactic Radiosurgery: Preliminary Result in Kaohsiung Chang Gung Memorial Hospital
摘要
Purpose: For reporting the preliminary result of brain arteriovenous malformation (AVM) treated with single fraction stereotactic radiosurgery. Materials and Methods: From June 1994 through April 1998, 26 patients with brain AVM received stereotactic radiosurgery. The age of patients ranged from 12 to 77 years old (median: 28.5). We used 6 MV X-ray Siemens linear accelerator. The median prescribed dose was 15 Gy (range: 10-18.73 Gy) to the nidus margin. The minimal dose ranged from 4.62 to 15.13 Gy (median 11.88 Gy). The maximal dose ranged from 13.33 to 27.95 Gy (median 18.84 Gy). The mean target volume was 6.85 cm^3 (range: 0.63-25.76). Twenty-two patients were treated with one isocenter (4-6 arcs), 4 patients with 2 isoeenters (6-10 arcs). We evaluated the response rate and radiation-induced complication. Results: The follow-up angiogram or MRI studies in 21 patients revealed the complete obliteration rates in 1 and 2 years were 33% and 41%, respectively. With the minimal dose of≤13 and＞ 13 Gy, the 2-year complete obliteration rate was 17% and 60%, respectively (p = 0.0067). The 2-year complete obliteration rate was 44% and 34% with target volume ≤6 and ＞ 6 cm^3 (p = 0.6507), respectively. Higher ratio (＞85%) of minimal dose to prescribed dose was noted in 73% (11/15) and 27% (3/11) of the patients whose target volume was ≤6 and ＞6 cm^3 (p = 0.02), respectively. In multivariate analysis, minimal dose was an only significant factor for complete obliteration (p = 0.0495). One patient had hemorrhage 5 months after radiosurgery. Two patients had radiation-induced complications on MRI 14 to 21 months later after radiosurgery. Conclusion: Target volume and minimal dose may influence the obliteration rate of brain AVM. According to literature review, the complete obliteration rates in our series were lower than some reports. Lower prescribed doses may be the cause. Higher doses may improve the response rate.
並列摘要
Purpose: For reporting the preliminary result of brain arteriovenous malformation (AVM) treated with single fraction stereotactic radiosurgery. Materials and Methods: From June 1994 through April 1998, 26 patients with brain AVM received stereotactic radiosurgery. The age of patients ranged from 12 to 77 years old (median: 28.5). We used 6 MV X-ray Siemens linear accelerator. The median prescribed dose was 15 Gy (range: 10-18.73 Gy) to the nidus margin. The minimal dose ranged from 4.62 to 15.13 Gy (median 11.88 Gy). The maximal dose ranged from 13.33 to 27.95 Gy (median 18.84 Gy). The mean target volume was 6.85 cm^3 (range: 0.63-25.76). Twenty-two patients were treated with one isocenter (4-6 arcs), 4 patients with 2 isoeenters (6-10 arcs). We evaluated the response rate and radiation-induced complication. Results: The follow-up angiogram or MRI studies in 21 patients revealed the complete obliteration rates in 1 and 2 years were 33% and 41%, respectively. With the minimal dose of≤13 and＞ 13 Gy, the 2-year complete obliteration rate was 17% and 60%, respectively (p = 0.0067). The 2-year complete obliteration rate was 44% and 34% with target volume ≤6 and ＞ 6 cm^3 (p = 0.6507), respectively. Higher ratio (＞85%) of minimal dose to prescribed dose was noted in 73% (11/15) and 27% (3/11) of the patients whose target volume was ≤6 and ＞6 cm^3 (p = 0.02), respectively. In multivariate analysis, minimal dose was an only significant factor for complete obliteration (p = 0.0495). One patient had hemorrhage 5 months after radiosurgery. Two patients had radiation-induced complications on MRI 14 to 21 months later after radiosurgery. Conclusion: Target volume and minimal dose may influence the obliteration rate of brain AVM. According to literature review, the complete obliteration rates in our series were lower than some reports. Lower prescribed doses may be the cause. Higher doses may improve the response rate.