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目的 回顾性分析分次立体定向放射治疗脑动静脉畸形 (AVM)远期疗效及相关因素。方法 3 4例脑动静脉畸形应用多分次立体定向放射治疗 ,6MV -X射线累积剂量DT42 -5 6GY ,1-3个中心 ,80 %～ 90 %等剂量曲线包绕肿瘤边缘 ,病灶体积 0 .3 8～ 45 .68cm3;分割方式 :6～ 7GY 次 ,3次 周。结果 随访 3～ 4年 ,AVM闭塞率 64 .71% (2 2 3 4) ,疗后 2年再出血率为 5 .88% (2 3 4)。结果显示总生物剂量相同时 ,病灶体积大小是影响AVM疗效的关键因素。AVM的体积 <10cm3闭塞率为 87.5 % (14 16) ,明显高于体积 >10cm3的 44 .44 % (8 18) (P <0 .0 1)。平均闭塞恢复期与治疗体积有关 ,体积 <10cm3的 1.2 2 2年短于体积 10cm3的 1.769年 (P <0 .0 5 )。结论 总生物剂量均为 80GY左右时 ,多分次立体定向放射治疗脑AVM的体积 <10cm3有较高的闭塞率且完全闭塞所需时间较短 ,是外科手术及血管内栓塞的有效补充治疗手段。
Objective To retrospectively analyze the long-term effects and related factors of fractionated stereotactic radiation therapy on cerebral arteriovenous malformations (AVM). Methods 34 cases of cerebral arteriovenous malformations were treated with multidimensional stereotactic radiotherapy. The cumulative dose of 6MV-X-ray was DT42-56GY with 1-3 centers. The isodose curve of 80% -90% wrapped the tumor margin and the lesion volume was 0. 3 8 ~ 45 .68 cm3; segmentation method: 6 ~ 7GY times, 3 weeks. Results The follow-up ranged from 3 to 4 years. The occlusion rate of AVM was 64.71% (2 23 4). The rate of rebleeding 2 years after treatment was 5.88% (23 4). The results showed that the same total biological dose, the lesion size is the key factor affecting the efficacy of AVM. The occlusion rate of AVM volume <10cm3 was 87.5% (14 16), which was significantly higher than 44 .44% (8 18) volume> 10cm3 (P <0.01). The mean occlusion recovery period was related to the volume of treatment, with a volume of <10 cm 3 of 1.222 years shorter than the volume of 10 cm 3 for 7.66 years (P <0.05). Conclusion When the total biological dose is about 80 Gy, the AVM volume of multi-division stereotactic radiotherapy has a higher occlusion rate and a shorter time for complete occlusion of the brain AVM. It is an effective supplementary treatment for surgical and endovascular embolization.