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动脉静脉形形通过立体射线手术治疗 - - 审查澳大利亚单一中心的经验
Daniel Morris1, Janet R Williams2, Belinda Vangelov3
1University of New South Wales, Faculty of Medicine and Health, Randwick, NSW 2031, Australia.
概括
线性加速器立体性放射性手术 (SRS) 有效地消除了大脑动脉静脉形 (AVM). 较高的辐射剂量 (≥18 Gy) 显著预测成功的消灭,而较大的AVM (3-6厘米) 不太可能被消灭.
科学领域:
- 神经外科 神经外科
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
背景情况:
- 动脉静脉形 (AVM) 是大脑中复杂的血管病变.
- 使用线性加速器 (LINAC) 的立体辐射手术 (SRS) 是AVMs的一种非侵入性治疗选择.
- 评估治疗结果和确定AVM消灭的预测因素至关重要.
研究的目的:
- 为了评估用基于LINAC的SRS治疗的大脑AVM的消灭率.
- 确定影响消灭率,消灭时间和SRS后并发症的因素.
- 将结果与现有文献进行比较,包括马刀治疗.
主要方法:
- 从电子医疗记录中对患者记录进行回顾性审计.
- 从总共219名接受治疗的患者中分析了136例具有已知的最终状态的AVM病例.
- 统计分析包括单变量和多变量分析,以确定预测因素.
主要成果:
- 总体AVM消灭率达到了75.7%.
- 删除率为1年后的5%,3年后的30%,4年后的46%.
- 辐射剂量≥18灰 (Gy) 是消灭的显著预测因素 (OR 4.7),而3-6厘米的巢穴大小不太可能实现消灭 (OR 0.2).
- 女性患者有较高的暂时并发症风险 (OR 2.8),多次SRS疗程增加了永久并发症的风险 (OR 7.1).
结论:
- 基于LINAC的SRS实现了与现有文献相比较的AVM消灭率.
- 辐射剂量≥18 Gy是成功消除AVM的关键因素.
- 卵巢大小和患者的性别是治疗计划和并发症风险评估的重要考虑因素.
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