Dose-volume prediction of radiation-related complications after hypofractionated conformal radiotherapy for brain metastases in critical areas

Inoué, Hiroshi; Sato, Hiro; Suzuki, Yoshiyuki; Saitoh, Jun‐ichi; Noda, Shin‐ei; Seto, Ken-ichi; Torikai, Kohei; Nakano, Takashi

doi:10.7759/cureus.189

Cited by 2 publications

(7 citation statements)

References 23 publications

(29 reference statements)

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“…The maximum dose was calculated based on the marginal dose and prescribed isodose. For the purpose of the dose-volume analysis, the maximum dose in three- to ten-fraction treatment was converted to the SDE using the equation reported by Park et al and Eaton et al [ 8 , 12 ], as previously reported [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…The isodose volume of the surrounding brain (excluding the GTV) circumscribed with an SDE of 14 Gy (V14), as well as the tumor volume, was measured using the MultiPlan software program for the G4 system (Accuray, Sunnyvale, CA) and recorded in each patient in order to obtain the optimal dose and fractionation schedule. The SDE of 14 Gy used in three- to ten-fraction treatment was 23.1 to 38.4 Gy according to Timmerman’s values [ 13 ], as previously reported [ 10 ]. The V14 of each tumor was maintained at less than 7 cm 3 in order to prevent radiation necrosis for optimal treatment based on the dose-volume prediction of complications [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…The SDE of 14 Gy used in three- to ten-fraction treatment was 23.1 to 38.4 Gy according to Timmerman’s values [ 13 ], as previously reported [ 10 ]. The V14 of each tumor was maintained at less than 7 cm 3 in order to prevent radiation necrosis for optimal treatment based on the dose-volume prediction of complications [ 10 ]. If the V14 value was more than 7 cm 3 in the first dose-plan, it was lowered to less than 7 cm 3 using a decreased marginal isodose or dose or an increased number of fractions in the revised or re-revised dose-plan, maintaining an effective marginal dose (SDE: 18–20 Gy) on the target.…”

Section: Methodsmentioning

confidence: 99%

“…Symptomatic brain edema was identified in association with neurological deterioration and imaging changes in the concomitant perifocal regions after treatment. The tumor response was divided into three groups, reduced (a decrease in the tumor volume of >15%), stable (a change in the tumor volume within ±15%) or enlarged (an increase in the tumor volume of >15%), in order to compare the response with that observed in former reports of large brain metastases [ 9 , 10 ]. The incidence of complications was examined in relation to the V14 of the surrounding brain.…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported that the brain volume circumscribed with a single dose equivalent (SDE) of 14 Gy (V14) is an indicator of radiation necrosis [ 9 ] and that the incidence of radiation-related complications after hypofractionated conformal radiotherapy is best predicted according to the dose-volume relationship using the SDE of the maximum dose and V14 [ 10 ]. In January 2010, we initiated a prospective study of optimal hypofractionated conformal radiotherapy based on risk prediction in order to avoid radiation necrosis after hypofractionation treatment for large brain metastases in addition to the Kjellberg’s necrosis risk line used in single-session radiosurgery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study

Inoué¹,

Sato²,

Suzuki

et al. 2014

Radiat Oncol

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BackgroundA single-institutional prospective study of optimal hypofractionated conformal radiotherapy for large brain metastases with high risk factors was performed based on the risk prediction of radiation-related complications.MethodsEighty-eight patients with large brain metastases ≥10 cm3 in critical areas treated from January 2010 to February 2014 using the CyberKnife were evaluated. The optimal dose and number of fractions were determined based on the surrounding brain volume circumscribed with a single dose equivalent (SDE) of 14 Gy (V14) to be less than 7 cm3 for individual lesions. Univariate and multivariate analyses were conducted.ResultsAs a result of optimal treatment, 92 tumors ranging from 10 to 74.6 cm3 (median, 16.2 cm3) in volume were treated with a median prescribed isodose of 57% and a median fraction number of five. In order to compare the results according to the tumor volume, the tumors were divided into the following three groups: 1) 10–19.9 cm3, 2) 20–29.9 cm3 and 3) ≥30 cm3. The lesions were treated with a median prescribed isodose of 57%, 56% and 55%, respectively, and the median fraction number was five in all three groups. However, all tumors ≥20 cm3 were treated with ≥ five fractions. The median SDE of the maximum dose in the three groups was 47.2 Gy, 48.5 Gy and 46.5 Gy, respectively. Local tumor control was obtained in 90.2% of the patients, and the median survival was nine months, with a median follow-up period of seven months (range, 3-41 months). There were no significant differences in the survival rates among the three groups. Six tumors exhibited marginal recurrence 7-36 months after treatment. Ten patients developed symptomatic brain edema or recurrence of pre-existing edema, seven of whom required osmo-steroid therapy. No patients developed radiation necrosis requiring surgical resection.ConclusionOur findings demonstrate that the administration of optimal hypofractionated conformal radiotherapy based on the dose-volume prediction of complications (risk line for hypofractionation), as well as Kjellberg’s necrosis risk line used in single-session radiosurgery, is effective and safe for large brain metastases or other lesions in critical areas.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study

Inoué¹,

Sato²,

Suzuki

et al. 2014

Radiat Oncol

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One-Day Two-Fraction Radiosurgery for Brain Metastases Using Gamma Knife

Mori¹,

Kida

Matsushita

et al. 2019

Cureus

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Objective: We aimed to evaluate the feasibility of a one-day two-fraction Gamma Knife radiosurgery (GKRS) for brain metastases. Cases and methods: Ten cases with ten brain metastases (four cases of lung adenocarcinoma, one small cell lung carcinoma (SCLC), two renal cell carcinoma, one breast cancer, one esophageal carcinoma, and one bile duct carcinoma) were treated by one-day two-fraction (with an interval of more than six hours) GKRS under rigid skull frame fixation. Of the ten brain metastases, five lesions were in the frontal lobe, one in temporal, one in occipital, and three in the cerebellar hemisphere. The mean planning target volume (PTV) of the ten brain tumors was 7.8 ml (median, 8.0; range, 3.8-11.8). The ten targets of the mean prescription isodose volume (PIV) of 10.1 ml (median, 10.1; range, 4.4-15.9) were treated with a mean margin dose of 20.4 Gy (median, 20.5; range, 16.4-22) in two fractions. In five cases, other small brain metastases (one to seven tumors) were also treated simultaneously in a single fraction GKRS. The indication of two-fraction radiosurgery was large lesion size in eight, retreatment in three, the proximity of the motor area in three, and pre-existing perifocal edema symptom of dysarthria in two, nausea and vomiting in one, and dementia in one. Results: Eight cases were alive at the end of the follow-up period of one to nine months (median, 6). One patient with SCLC died four and a half months after GKRS, from aggressive regrowth of the treated frontal lesion after transient marked shrinkage. Another patient died four months after GKRS due to the progression of other brain tumors treated by single fraction GKRS at the same time. In nine of 10 cases, the size of the treated tumors was controlled until the end of the follow-up period or the patient's death. In two cases, an additional GKRS was performed for newly developed brain metastases at distant locations at six months and five months after one-day two-fraction GKRS, respectively, and controlled at the end of the followup period. Conclusions: A relatively high dose may be safely delivered to large lesions, to those close to the important structures, or those with perifocal edema by one-day two-fraction radiosurgery. Local control was good except for a relapsed SCLC metastasis case. Evaluation in more cases with a longer follow-up period is necessary to determine definite indications and optimal prescription doses.

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Dose-volume prediction of radiation-related complications after hypofractionated conformal radiotherapy for brain metastases in critical areas

Cited by 2 publications

References 23 publications

Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study

Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study

One-Day Two-Fraction Radiosurgery for Brain Metastases Using Gamma Knife

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