The Efficacy Of 3DCRT For 20 Patients With Refractory Vascular Malformation In Adulthood

Objective:To investigate the efficacy of 3DCRT,clinical features and diagnosis for patients with refractory vascular malformations in adult.Method:Between 1998 and 2008,20 patients(9 male,11 female) with refractory vascular malformation in adulthood were treated with 6MV X-ray with a total dose ranging from 30 to 50 Gy(a median of 40 Gy) by 3DCRT(3 dimensional conformal radiation therapy).There were 7 patients with vascular malformation in oral and maxillofacial region(or 2 cases with lesions in the cavernous sinus and maxillofacial region),3 in the cavernous sinus,5 in the vertebrae(or 3 cases with the partial paraplegia) and 5 in other regions.The efficacy of treatment were evaluated by clinic and/or imageologic examinations.Results:Of the 20 evaluable cases,the symptoms were disappeared in 80.0%,relieved in 13.3%and no response in 6.7%with symptomatic lesions after 3DCRT.The lesion regions in MRI or CT scan were minimized in 90.0%and no changes in 10.0%after 3DCRT.The symptoms were disappeared in 100%with symptomatic lesions,the contours satisfied and no manifest complication with radiotherapy observed in all patients,and the overall response rate(the lesion regions disappeared or minimized) was 100%in imageology in six or twelve months after 3DCRT.Conclusions:3DCRT is effective and safe for refractory vascular malformation in adulthood on condition of a suitable total dose range of 30 to 45 Gy,and may be a principal treatment method for vascular malformation lesions or be used as remedial therapy for postoperative remains and relapse of vascular malformation lesion.The symptoms after treatment are gradually relieved or disappear in two to four weeks,but the imageology shows slow and delayed improvement of lesion regions,and the diagnostic images in MRI or CT scan show that lesion regions are disappeared or minimized in sixth to twelfth month after treatment.The improvement in vertebral vascular malformation lesion is slow and delayed in three to six months after treatment.On condition of paraplegia symptoms being achieved partial or no response to the treatment,the paraplegic patients with vertebral vascular malformation are acutely treated by successive hyperbaric oxygen(HBO) treatment and spend tissue edemas time of three to six months after radiation therapy.HBO now appears to be improving spinal cord aerobic metabolism at a cellular level,namely,by enhancing damaged nerve recovery.