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Open AccessArticle
Fractionated Stereotactic Intensity-Modulated Radiotherapy for Large Brain Metastases: Comprehensive Analyses of Dose–Volume Predictors of Radiation-Induced Brain Necrosis
by
Taro Murai
Taro Murai 1,2,*,
Yuki Kasai
Yuki Kasai 3,
Yuta Eguchi
Yuta Eguchi 3,
Seiya Takano
Seiya Takano 2,
Nozomi Kita
Nozomi Kita 2,
Akira Torii
Akira Torii 2,
Taiki Takaoka
Taiki Takaoka 2,
Natsuo Tomita
Natsuo Tomita 2,
Yuta Shibamoto
Yuta Shibamoto 4 and
Akio Hiwatashi
Akio Hiwatashi 2
1
Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Kanagawa, Japan
2
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
3
Department of Radiology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8602, Aichi, Japan
4
Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi 441-8021, Aichi, Japan
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(19), 3327; https://doi.org/10.3390/cancers16193327 (registering DOI)
Submission received: 9 August 2024
/
Revised: 22 September 2024
/
Accepted: 24 September 2024
/
Published: 28 September 2024
Simple Summary
To examine predictors of brain necrosis (BN) in fractionated SRT for BMs, comprehensive analyses of dosimetric parameters were conducted. The normal brain volume receiving an xx Gy biological dose in 2 Gy fractions (VxxEQD2) was calculated, and collinearities were carefully excluded. Three-fraction SRT was delivered to 34 patients with 75 BMs, five-fraction SRT to 58 patients with 104 BMs, and ten-fraction SRT to 20 patients with 37 BMs depending on the target volume. The incidence of BN was also significantly higher in cases with V55EQD2 > 30 cc or V60EQD2 > 20 cc. These doses correspond to 28 or 30 Gy/5 fr and 37 or 40 Gy/10 fr, respectively. These biologically high doses may affect BN incidence. Thus, the planning target volume margin should be minimized as much as possible.
Abstract
Background: The objective was to explore dosimetric predictors of brain necrosis (BN) in fractionated stereotactic radiotherapy (SRT). Methods: After excluding collinearities carefully, multivariate logistic models were developed for comprehensive analyses of dosimetric predictors in patients who received first-line fractionated SRT for brain metastases (BMs). The normal brain volume receiving an xx Gy biological dose in 2 Gy fractions (VxxEQD2) was calculated from the retrieved dose–volume parameters. Results: Thirty Gy/ 3 fractions (fr) SRT was delivered to 34 patients with 75 BMs (median target volume, 3.2 cc), 35 Gy/5 fr to 30 patients with 57 BMs (6.4 cc), 37.5 Gy/ 5 fr to 28 patients with 47 BMs (20.2 cc), and 40 Gy/10 fr to 20 patients with 37 BMs (24.3 cc), according to protocols, depending on the total target volume (p < 0.001). After excluding the three-fraction groups, the incidence of symptomatic BN was significantly higher in patients with a larger V50EQD2 (adjusted odds ratio: 1.07, p < 0.02), V55EQD2 (1.08, p < 0.01), or V60EQD2 (1.09, p < 0.01) in the remaining five- and ten-fraction groups. The incidence of BN was also significantly higher in cases with V55EQD2 >30 cc or V60EQD2 >20 cc (p < 0.05). These doses correspond to 28 or 30 Gy/5 fr and 37 or 40 Gy/10 fr, respectively. Conclusions: In five- or ten-fraction SRT, larger V55EQD2 or V60EQD2 are BN risk predictors. These biologically high doses may affect BN incidence. Thus, the planning target volume margin should be minimized as much as possible.
Share and Cite
MDPI and ACS Style
Murai, T.; Kasai, Y.; Eguchi, Y.; Takano, S.; Kita, N.; Torii, A.; Takaoka, T.; Tomita, N.; Shibamoto, Y.; Hiwatashi, A.
Fractionated Stereotactic Intensity-Modulated Radiotherapy for Large Brain Metastases: Comprehensive Analyses of Dose–Volume Predictors of Radiation-Induced Brain Necrosis. Cancers 2024, 16, 3327.
https://doi.org/10.3390/cancers16193327
AMA Style
Murai T, Kasai Y, Eguchi Y, Takano S, Kita N, Torii A, Takaoka T, Tomita N, Shibamoto Y, Hiwatashi A.
Fractionated Stereotactic Intensity-Modulated Radiotherapy for Large Brain Metastases: Comprehensive Analyses of Dose–Volume Predictors of Radiation-Induced Brain Necrosis. Cancers. 2024; 16(19):3327.
https://doi.org/10.3390/cancers16193327
Chicago/Turabian Style
Murai, Taro, Yuki Kasai, Yuta Eguchi, Seiya Takano, Nozomi Kita, Akira Torii, Taiki Takaoka, Natsuo Tomita, Yuta Shibamoto, and Akio Hiwatashi.
2024. "Fractionated Stereotactic Intensity-Modulated Radiotherapy for Large Brain Metastases: Comprehensive Analyses of Dose–Volume Predictors of Radiation-Induced Brain Necrosis" Cancers 16, no. 19: 3327.
https://doi.org/10.3390/cancers16193327
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