- 期刊
Image-Guided Stereotactic Radiosurgery Using Volumetric Modulated Arc Therapy for Arteriovenous Malformation of the Brain: Experiences of a Single Institution
以弧形調控之影像導航立體定位放射手術治療腦部動靜脈畸形：我們的經驗
摘要
目的：評估以弧形調控之影像導航立體定位放射手術治療腦部動靜脈畸形之成效。材料與方法：回顧研究於2010年3月至2012年11月期間，分析接受影像導航立體定位放射手術之腦部動靜脈畸形患者。共有20位腦部動靜脈畸形的病患接受治療。他們的診斷年齡中位數為40歲，14位病患為男性（70%），6位病患為女性（30%）。5位病患有接受過手術，2位病患有接受過血管栓塞，單純觀察療法並沒有用在任何病患身上。立體定位放射手術劑量的中位數為18 Gy，治療區域體積中位數為3.6 c.c。結果：追蹤期間中位數為11.8個月。接受治療之後，其中有4位患者（20%）腦部動靜脈畸形完全消退，8位患者（40%）部分消退，其餘8位患者（40%）則為穩定疾病狀態。一年、兩年、三年的消退率分別為40%、55%與60%。結論：以弧形調控之影像導航立體定位放射手術治療腦部動靜脈畸形之成效，在追蹤期間中位數為11.8個月之後，可達整體60%之消退率。而一年、兩年、三年的消退率則分別為40%、55%與60%。患者必需接受更長時間的追蹤以獲致更精確的治療成效分析。
並列摘要
Purpose: To evaluate the therapeutic effects of brain arteriovenous malformation (AVM) treated with image-guided stereotactic radiosurgery using volumetric modulated arc therapy. Material and Methods: From March 2010 through November 2012, there were 20 patients with brain AVM treated with image-guided stereotactic radiosurgery in our institution. The median age at diagnosis was 40 years (ranged from 9 to 74 years). Fourteen patients were male (70%) and 6 were female (30%). Among all these 20 patients, 5 patients (25%) had previous surgery of craniotomy with excision, and 2 patients (10%) received previous endovascular embolization. No patients had been managed with observation only at the time of diagnosis. The median dose of stereotactic radiosurgery was 18 Gy (ranged from 12 to 20 Gy). The median clinical target volume was 3.6 c.c (ranged from 1.5 to 15.5 c.c). Results: The median follow-up period was 11.8 months (ranged from 4.7 to 35.4 months). Four patients (20%) had complete obliteration, 8 patients (40%) had partial obliteration, while 8 patients (40%) had stable diseases after treatments. The actuarial 1-year, 2-year and 3-year obliteration rates were 40%, 55% and 60%, respectively. Conclusion: The therapeutic effects of brain AVM treated with image-guided stereotactic radiosurgery using volumetric modulated arc therapy achieved 60% of both complete and partial obliteration rate within the median follow-up period of 11.8 months. The actuarial 1-year, 2-year and 3-year obliteration rates were 40%, 55% and 60%, respectively. The long-term follow-up duration should be warranted to evaluate the further treatment results.