Avaliação da resposta à reirradiação em malformações arteriovenosas com radiocirurgia em acelerador linear.
Nenhuma Miniatura disponível
Arquivos
Data
2013
Autores
Moraes, Paulo Lazaro de [UNIFESP]
Orientadores
Segreto, Roberto Araujo [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: O objetivo do presente trabalho e avaliar a evolucao clinica de pacientes portadores de Malformacoes Arteriovenosas cerebrais (MAV) submetidos a reirradiacao com dose unica em Acelerador Linear. Metodos: Estudo retrospectivo com 37 pacientes portadores de malformacao arteriovenosa submetidos a reirradiacao em acelerador linear, no periodo de abril de 2003 a novembro de 2011, no Hospital Sao Joaquim da Beneficencia Portuguesa de São Paulo. Caracteristicas individuais como sexo, cor, idade, uso de medicacoes e comorbidades; da doenca como classificacao Spetzler-Martin, localizacao e volume; e do tratamento como embolizacao, dose de prescricao, numero de campos estaticos e arcos, volume das curvas de dose de radioterapia e indice de conformidade foram analisados. Durante o seguimento foram realizados exames de imagem para avaliacao das alteracoes pos-tratamento e cura da MAV. As complicacoes decorrentes do procedimento foram classificadas como sintomaticas e assintomaticas. Resultados: A porcentagem de oclusao angiografica apos reirradiacao foi de 55,5%. Em tres pacientes que nao apresentaram oclusao angiografica foi possivel exerese cirurgica. Observou-se que a reducao do volume do nidus maior que 50% apos o primeiro procedimento foi o fator preditivo mais importante para sua oclusao. Outro fator correlacionado a cura da MAV foi a dose de prescricao maior que 15,5 Gy na primeira radicirurgia. Dois pacientes apresentaram deficit neurologico permanente, e os fatores que se correlacionaram as complicacoes foram dose de prescricao e dose maxima no primeiro procedimento. Conclusao: A reirradiacao com dose unica em malformacoes arteriovenosas e um procedimento seguro e factivel e os candidatos que podem nao se beneficiar do procedimento sao aqueles que receberam dose de prescricao menor que 15,5 Gy no primeiro procedimento, e tiveram reducao menor do que 50% do volume da MAV antes da reirradiacao
Objective: The objective of this study is to evaluate the clinical outcome of patients undergoing single dose reirradiation in brain Arteriovenous Malformations (AVM) in Linear Accelerator (LINAC) Methods: A retrospective study of 37 patients with brain AVM who underwent LINAC reirradiation in the period between April 2003 and November 2011 at São Joaquim Hospital – Beneficência Portuguesa, in São Paulo. Individual characteristics such as gender, age, use of medications and comorbidities; disease as Spetzler-Martin classification, location and volume, and treatment such as embolization, prescription dose, radiotherapy dose volume curves and conformity index were analyzed. During follow-up imaging studies were performed to evaluate changes after treatment and AVM cure. The complications of the procedure were classified as symptomatic and asymptomatic. Results: The percentage of angiographic occlusion after reirradiation was 55,5%. In three patients it was possible to perform surgical excision, with 66,6% cure rate. It was observed that the nidus volume reduction greater than 50% after the first procedure was the most important predictor for occlusion. Another factor that correlates to the cure of the AVM was a prescription dose greater than 15,5 Gy in the first radiosurgery. Two patients had permanent neurologic deficits, and the factors that correlated with the complications were prescription dose and maximum dose in the first procedure. Conclusion: The study suggests that single dose reirradiation to Arteriovenous Malformations is safe and the success of the procedure is related to the prescription dose greater than 15,5 Gy in first radiosurgery and reduction of more than 50% of the AVM volume before reirradiation.
Objective: The objective of this study is to evaluate the clinical outcome of patients undergoing single dose reirradiation in brain Arteriovenous Malformations (AVM) in Linear Accelerator (LINAC) Methods: A retrospective study of 37 patients with brain AVM who underwent LINAC reirradiation in the period between April 2003 and November 2011 at São Joaquim Hospital – Beneficência Portuguesa, in São Paulo. Individual characteristics such as gender, age, use of medications and comorbidities; disease as Spetzler-Martin classification, location and volume, and treatment such as embolization, prescription dose, radiotherapy dose volume curves and conformity index were analyzed. During follow-up imaging studies were performed to evaluate changes after treatment and AVM cure. The complications of the procedure were classified as symptomatic and asymptomatic. Results: The percentage of angiographic occlusion after reirradiation was 55,5%. In three patients it was possible to perform surgical excision, with 66,6% cure rate. It was observed that the nidus volume reduction greater than 50% after the first procedure was the most important predictor for occlusion. Another factor that correlates to the cure of the AVM was a prescription dose greater than 15,5 Gy in the first radiosurgery. Two patients had permanent neurologic deficits, and the factors that correlated with the complications were prescription dose and maximum dose in the first procedure. Conclusion: The study suggests that single dose reirradiation to Arteriovenous Malformations is safe and the success of the procedure is related to the prescription dose greater than 15,5 Gy in first radiosurgery and reduction of more than 50% of the AVM volume before reirradiation.
Descrição
Citação
MORAES, Paulo Lázaro de. Avaliação da resposta à reirradiação em malformação arteriovenosas com radiocirurgia em acelerador linear. 2013. 53 f. Tese (Doutorado) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2013.