Improved effectiveness of stereotactic radiosurgery in large brain metastases by individualized isotoxic dose prescription

Autor: Jacqueline Schiffelers, Aswin L. Hoffmann, Jaap D. Zindler, Philippe Lambin
Přispěvatelé: RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Radiotherapie
Jazyk: angličtina
Rok vydání: 2018
Předmět:
PROTOCOL
Dosisverschreibung
medicine.medical_treatment
Normal tissue
Radiosurgery
NSCLC
Strahlentherapie
TOXICITY
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Therapeutic index
medicine
Radiology
Nuclear Medicine and imaging
Computer Simulation
Stereotaktisch
Precision Medicine
Dose prescription
Normalgewebetoleranz
Radiotherapy
Large brain metastases
business.industry
Brain Neoplasms
HYPOFRACTIONATION
Radiotherapy Planning
Computer-Assisted
Dose fractionation
Radiotherapy Dosage
Tumor control
EFFICACY
TUMORS
Tumor Burden
Radiation therapy
Increased risk
Oncology
030220 oncology & carcinogenesis
Stereotactic
Normal tissue tolerance
RADIATION-ONCOLOGY
Original Article
TRIAL
Dose Fractionation
Radiation
Große Hirnmetastasen
Nuclear medicine
business
Tomography
X-Ray Computed
Zdroj: Strahlentherapie Und Onkologie
Strahlentherapie Und onkologie, 194(6), 560-569. Springer
ISSN: 0179-7158
DOI: 10.1007/s00066-018-1262-x.pdf
Popis: Introduction In large brain metastases (BM) with a diameter of more than 2aEuro ($) over bar cm there is an increased risk of radionecrosis (RN) with standard stereotactic radiosurgery (SRS) dose prescription, while the normal tissue constraint is exceeded. The tumor control probability (TCP) with a single dose of 15Gy is only 42%. This in silico study tests the hypothesis that isotoxic dose prescription (IDP) can increase the therapeutic ratio (TCP/Risk of RN) of SRS in large BM. Materials and methods A treatment-planning study with 8 perfectly spherical and 46 clinically realistic gross tumor volumes (GTV) was conducted. The effects of GTV size (0.5-4cm diameter), set-up margins (0, 1, and 2mm), and beam arrangements (coplanar vs non-coplanar) on the predicted TCP using IDP were assessed. For single-, three-, and five-fraction IDP dose-volume constraints of V-12Gy=10cm(3), V-19.2Gy=10cm(3), and a V-20Gy=20cm(3), respectively, were used to maintain a low risk of radionecrosis. Results In BM of 4cm in diameter, the maximum achievable single-fraction IDP dose was 14Gy compared to 15Gy for standard SRS dose prescription, with respective TCPs of 32 and 42%. Fractionated SRS with IDP was needed to improve the TCP. For three- and five-fraction IDP, a maximum predicted TCP of 55 and 68% was achieved respectively (non-coplanar beams and a 1mm GTV-PTV margin). Conclusions Using three-fraction or five-fraction IDP the predicted TCP can be increased safely to 55 and 68%, respectively, in large BM with a diameter of 4cm with a low risk of RN. Using IDP, the therapeutic ratio of SRS in large BM can be increased compared to current SRS dose prescription.
Databáze: OpenAIRE
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