脑动静脉畸形三维适形放疗的临床研究

Three dimensional conformal radiotherapy for cerebral arteriovenous malformation

目的:探讨三维适形放疗(3DCRT)治疗脑动静脉畸形(AVM)的价值。方法:42例经数字减影血管造影(DSA)或MR+MRA证实的单发脑动静脉畸形患者。畸形血管团体积1.2～48.6cm3,平均值6.4cm3,其中23例<5cm3,15例为5～10cm3,4例>10.0cm3。治疗剂量20～24d共60～70Gy/20～24次。随访时间分别为1、2及3年。结果:<5cm3病灶1、2、3年内畸形血管团完全闭塞分别占73.9%(17/23)、82.6%(19/23)及95.7%(22/23)。5～10cm3畸形血管团完全闭塞分别占66.6%(10/15)、80.6%(12/15)及86.7%(13/15)。>10cm3病灶畸形血管团完全闭塞分别为2例(50.0%)、2例(50.0%)及3例(75.0%),28例癫痫患者症状完全消除18例(64.3%),症状缓解8例(28.6%),无明显改善2例(7.1%)。2例出现放射性脑水肿。结论:3DCRT是治疗脑血管畸形安全而有效的治疗方法,它是脑AVM治疗的重要手段之一。

OBJECTIVE： To evaluate the value of three dimensional conformal radiotherapy for cerebral arteriovenous malformation （AVM）. METHODS： Forty-two patients with cerebral arteriovenous malformation confirmed by DSA or MR combined MRA were studied. The nidus volumes was from 1. 2 cm^3 to 48. 6 cm^3 , mean 6.4 cm^3. The nidus volumes were smaller than 5.0 cm^3 in 23 cases. The range of nidus volume in size was from 5.0 cm^3 to 10.0 cm^3 in 15 cases. They were larger than 10.0 cm^3 in 4 cases. The TDF was 60-70 Gy/20- 24 f（20-24 d）. The follow-up time was the first year, the second year and the third year after therapy respectively for all patients. RESULTS： After radiotherapy, the 1,2,3 year complete obliteration rates of their AVMs which the nidus volume was smaller than 5 cm^3 were 73.9%（17/23）,82.6%（19/23）and 95.0% （22/23） respectively, the 1,2,3 year complete obliteration rates of the volume from 5-10 cm^3 were 66.6% （10/15） ,80. 0% （13/15） ,86. 9% （13/15） respectively and the 1,2,3 year complete obliteration rates of the volume biger than 10 cm^3 were 50.0 % （2/4）, 50. 0 % （ 2/4 ）, 75. 0 % （ 3/4 ） respectively. Epilepsy was eliminated in 18（64.3 % ）. The symptom was alleviative in 8 （28.6 % ）. There was not catabatic in 2 cases（7.1 % ）. Cerebral edema irradiated occurred in 2 cases. CONCLUSION： Three dimensional conformal radiotherapy is one of the effective therapies for cerebral AVM. Three dimensional conformal radiotherapy may be an important alternative to other therapy in patients with large AVM.