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目的 回顾性分析X射线立体定向放射治疗 (SRT)青少年脑动静脉畸形 (AVM)的远期疗效、并发症及影响因素。方法 6 6例青少年脑AVM采用X射线SRT治疗 ,病灶体积 0 .32～ 4 2 .88cm3 ,周边剂量 18～ 2 3Gy。结果 随访 3～ 5年 ,AVM闭塞率 6 5 .2 % ,疗后 2年再出血率 4 .6 %。多因素回归分析结果显示周边剂量在 18～ 2 3Gy范围时 ,病灶体积大小是影响AVM闭塞率的唯一因素 ,而周边剂量和年龄与其无关。AVM体积 <10cm3 的闭塞率 (87.1% )明显高于体积 >10cm3 的 (45 .7% )(χ2 =10 .6 4 4 ,P <0 .0 1)。平均闭塞恢复期与治疗体积及周边剂量均有关 ,体积 <10cm3 的 1.4 4 4年短于体积 >10cm3 的 1.813年 (t =2 .0 6 6 ,P <0 .0 5 ) ;周边剂量 >2 0Gy的 1.4 4 8年短于剂量 <2 0Gy的1.85 7年 (t=2 .2 4 7,P <0 .0 5 ) ;而与年龄无关 ,少年组与青年组的恢复期分别为 1.4 74年与 1.6 6 7年 (t=1.0 73,P >0 .0 5 )。结论 X射线SRT治疗体积 <10cm3 的脑AVM ,当周边剂量 >2 0Gy时 ,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补充治疗手段
Objective To retrospectively analyze the long-term effects, complications and influencing factors of cerebral arteriovenous malformation (AVM) in adolescents with X-ray stereotactic radiotherapy (SRT). Methods Sixty-six young adult brain AVMs were treated with X-ray SRT. The volume of lesion was 0.32-4.288 cm3, and the peripheral dose was 18-2 3Gy. Results The follow-up of 3 to 5 years, AVM occlusion rate of 65.2%, 2 years after rebleeding rate of 4.6%. Multivariate regression analysis showed that when the peripheral dose was in the range of 18 ~ 2 3Gy, the size of lesion was the only factor affecting the occlusion rate of AVM, while peripheral dose and age had nothing to do with it. The occlusion rate (87.1%) of the AVM volume <10 cm3 was significantly higher than that of the volume> 10 cm3 (45.7%) (χ2 = 10.644, P <0.01). The mean occlusion recovery period was related to the volume of treatment and the peripheral dose. The volume of <10cm3 in 1.444 was shorter than 1.813 in volume> 10cm3 (t = 2.606, P <0.05) The 1.4 Gy of 0Gy was shorter than 1.85 years (t = 2.247, P <0.05) at dose of <20 Gy, while the recovery was 1.4 74 Year and 1.667 years (t = 1.073, P> 0.05). Conclusion X-ray SRT is an effective treatment for brain AVM of volume <10cm3. When peripheral dose> 20 Gy, the higher occlusion rate and the shorter time needed for complete occlusion are the supplementary treatment of surgical operation and endovascular embolization