High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy
Abstract Purpose In this retrospective study, we aimed to evaluate the efficacy and incidence of radiation-induced brain necrosis (RBN) after volumetric modulated arc therapy-based stereotactic irradiation (VMAT-STI) for brain metastases. Methods In the 220 brain metastatic lesions included between...
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BMC
2025-01-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-024-02579-3 |
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| author | Takayuki Ohguri Hirohide Itamura Subaru Tani Eiji Shiba Junkoh Yamamoto |
| author_facet | Takayuki Ohguri Hirohide Itamura Subaru Tani Eiji Shiba Junkoh Yamamoto |
| author_sort | Takayuki Ohguri |
| collection | DOAJ |
| description | Abstract Purpose In this retrospective study, we aimed to evaluate the efficacy and incidence of radiation-induced brain necrosis (RBN) after volumetric modulated arc therapy-based stereotactic irradiation (VMAT-STI) for brain metastases. Methods In the 220 brain metastatic lesions included between January 2020 and June 2022, there were 1–9 concurrently treated lesions (median 1). A biologically effective dose (BED)10 of 80 Gy and a reduced BED10 of 50 Gy were prescribed to the gross tumor volume (GTV) and planning target volume (PTV) (PTV = GTV + 3 mm) margins, respectively. The number of fractions was adjusted from 3 to 15 to accommodate different GTV sizes; for larger tumor volumes, this was increased while maintaining the BED10 values comparable to those for GTV and PTV margins. Results Of the total patients, 16 (7%) exhibited locally progressive lesions; local tumor recurrence was observed in 2 (1%) patients, while RBN was noted in 14 (6%) patients. RBN was significantly more prevalent in the deep white matter around the lateral ventricles (DWM-LV) than in other sites, occurring in 9/22 (41%) lesions of metastases in the DWM-LV. The 2-year actuarial incidence risk of developing RBN was significantly higher in the DWM-LV (69%) than at other sites (5%). Conclusion The recurrence rate of brain metastases was low, and the incidence of RBN was lower in tumor sites other than the DWM-LV. However, the frequency of RBN was significantly higher in the DWM-LV region. Additional VMAT-STI-prescribed dose protocols are necessary to reduce RBN incidence in DWM-LVs. |
| format | Article |
| id | doaj-art-255991d66b31484eb70661cc9d72c77c |
| institution | Kabale University |
| issn | 1748-717X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj-art-255991d66b31484eb70661cc9d72c77c2025-01-12T12:33:57ZengBMCRadiation Oncology1748-717X2025-01-0120111110.1186/s13014-024-02579-3High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapyTakayuki Ohguri0Hirohide Itamura1Subaru Tani2Eiji Shiba3Junkoh Yamamoto4Department of Therapeutic Radiology, Hospital of the University of Occupational and Environmental HeathDepartment of Therapeutic Radiology, Hospital of the University of Occupational and Environmental HeathDepartment of Therapeutic Radiology, Hospital of the University of Occupational and Environmental HeathDepartment of Therapeutic Radiology, Hospital of the University of Occupational and Environmental HeathDepartment of Neurosurgery, School of Medicine, University of Occupational and Environmental HealthAbstract Purpose In this retrospective study, we aimed to evaluate the efficacy and incidence of radiation-induced brain necrosis (RBN) after volumetric modulated arc therapy-based stereotactic irradiation (VMAT-STI) for brain metastases. Methods In the 220 brain metastatic lesions included between January 2020 and June 2022, there were 1–9 concurrently treated lesions (median 1). A biologically effective dose (BED)10 of 80 Gy and a reduced BED10 of 50 Gy were prescribed to the gross tumor volume (GTV) and planning target volume (PTV) (PTV = GTV + 3 mm) margins, respectively. The number of fractions was adjusted from 3 to 15 to accommodate different GTV sizes; for larger tumor volumes, this was increased while maintaining the BED10 values comparable to those for GTV and PTV margins. Results Of the total patients, 16 (7%) exhibited locally progressive lesions; local tumor recurrence was observed in 2 (1%) patients, while RBN was noted in 14 (6%) patients. RBN was significantly more prevalent in the deep white matter around the lateral ventricles (DWM-LV) than in other sites, occurring in 9/22 (41%) lesions of metastases in the DWM-LV. The 2-year actuarial incidence risk of developing RBN was significantly higher in the DWM-LV (69%) than at other sites (5%). Conclusion The recurrence rate of brain metastases was low, and the incidence of RBN was lower in tumor sites other than the DWM-LV. However, the frequency of RBN was significantly higher in the DWM-LV region. Additional VMAT-STI-prescribed dose protocols are necessary to reduce RBN incidence in DWM-LVs.https://doi.org/10.1186/s13014-024-02579-3Radiation-induced brain necrosisStereotactic radiotherapyVolumetric modulated arc therapy |
| spellingShingle | Takayuki Ohguri Hirohide Itamura Subaru Tani Eiji Shiba Junkoh Yamamoto High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy Radiation Oncology Radiation-induced brain necrosis Stereotactic radiotherapy Volumetric modulated arc therapy |
| title | High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy |
| title_full | High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy |
| title_fullStr | High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy |
| title_full_unstemmed | High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy |
| title_short | High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy |
| title_sort | high incidence of radiation induced brain necrosis in the periventricular deep white matter stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy |
| topic | Radiation-induced brain necrosis Stereotactic radiotherapy Volumetric modulated arc therapy |
| url | https://doi.org/10.1186/s13014-024-02579-3 |
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