It is reported in the literature that the material used in an embolization of an arteriovenous malformation (AVM) can attenuate the radiation beams used in stereotactic radiosurgery (SRS) up to 10% to 15%. The purpose of this work is to assess the dosimetric impact of this attenuating material in the SRS treatment of embolized AVMs, using Monte Carlo simulations assuming clinical conditions. A commercial Monte Carlo dose calculation engine was used to recalculate the dose distribution of 20 AVMs previously planned with a pencil beam dose calculation algorithm. Dose distributions were compared using the following metrics: average, minimal and maximum dose of AVM, and 2D gamma index. The effect in the obliteration rate was investigated using radiobiological models. It was found that the dosimetric impact of the embolization material is less than 1.0 Gy in the prescription dose to the AVM for the 20 cases studied. The impact in the obliteration rate is less than 4.0%. There is reported evidence in the literature that embolized AVMs treated with SRS have low obliteration rates. This work shows that there are dosimetric implications that should be considered in the final treatment decisions for embolized AVMs.

译文

:据文献报道,用于动静脉畸形(AVM)栓塞的材料可使立体定向放射外科(SRS)中使用的辐射束衰减多达10%至15%。这项工作的目的是在假定临床条件的情况下,使用蒙特卡罗模拟评估该衰减材料在栓塞性AVM的SRS治疗中的剂量学影响。商业的蒙特卡洛剂量计算引擎用于重新计算以前用笔形束剂量计算算法计划的20个AVM的剂量分布。使用以下指标比较了剂量分布:AVM的平均,最小和最大剂量,以及2D伽玛指数。使用放射生物学模型研究了闭塞率的影响。发现在研究的20例病例中,栓塞材料对AVM的处方剂量对剂量的影响小于1.0 Gy。闭塞率的影响小于4.0%。文献中有证据表明,经SRS治疗的栓塞性AVM闭塞率低。这项工作表明在栓塞性AVM的最终治疗决策中应考虑剂量学意义。

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