- 作者：Jona A. Hattangadi ; M.D.&lowast ; ; Paul H. Chapman ; M.D.&dagger ; ; &Dagger ; ; Marc R. Bussiè ; re ; M.Sc.&Dagger ; ; Andrzej Niemierko ; Ph.D.&Dagger ; ; Christopher S. Ogilvy ; M.D.&dagger ; ; Alison Rowell ; B.S.&Dagger ; ; Juliane Daartz ; Ph.D.&Dagger ; ; Jay S. Loeffler ; M.D.&Dagger ; ; Helen A. Shih ; M.D. ; M.P.H.&Dagger ; ; hshih@partners.org
- 关键词：Cerebral arteriovenous malformation ; Proton stereotactic radiosurgery ; AVM score ; High-risk AVM
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 June, 2012
- 卷：83
- 期：2
- 页码：533-541
- 文件大小：492 K
Purpose
To evaluate patients with high-risk cerebral arteriovenous malformations (AVMs), based on eloquent brain location or large size, who underwent planned two-fraction proton stereotactic radiosurgery (PSRS).Methods and Materials
From 1991 to 2009, 59 patients with high-risk cerebral AVMs received two-fraction PSRS. Median nidus volume was 23 cc (range, 1.4-58.1 cc), 70%of cases had nidus volume 鈮?4 cc, and 34%were in critical locations (brainstem, basal ganglia). Median AVM score based on age, AVM size, and location was 3.19 (range, 0.9-6.9). Many patients had prior surgery or embolization (40%) or prior PSRS (12%). The most common prescription was 16 Gy radiobiologic equivalent (RBE) in two fractions, prescribed to the 90%isodose.
Results
At a median follow-up of 56.1 months, 9 patients (15%) had total and 20 patients (34%) had partial obliteration. Patients with total obliteration received higher total dose than those with partial or no obliteration (mean dose, 17.6 vs. 15.5 Gy (RBE), p = 0.01). Median time to total obliteration was 62 months (range, 23-109 months), and 5-year actuarial rate of partial or total obliteration was 33%. Five-year actuarial rate of hemorrhage was 22%(95%confidence interval, 12.5%-36.8%) and 14%(n = 8) suffered fatal hemorrhage. Lesions with higher AVM scores were more likely to hemorrhage (p = 0.024) and less responsive to radiation (p聽= 0.026). The most common complication was Grade 1 headache acutely (14%) and long term (12%). One patient developed a Grade 2 generalized seizure disorder, and two had mild neurologic deficits.
Conclusions
High-risk AVMs can be safely treated with two-fraction PSRS, although total obliteration rate is low and patients remain at risk for future hemorrhage. Future studies should include higher doses or a multistaged PSRS approach for lesions more resistant to obliteration with radiation.