Evolution and Dosimetric Analysis of Magnetic Resonance Imaging–Detected Brain Stem Injury After Intensity Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Huang, Xiao-Dan; Li, Yang-Chan; Chen, Fo-Ping; Zheng, Wei-Hong; Zhou, Guan Qun; Lin, Li; Hu, Jiang; He, Wenjun; Zhang, Lulu; Kou, Jia; Ma, Jun; Zhang, Weidong; Qi, Zhenyu

doi:10.1016/j.ijrobp.2019.04.032

Cited by 13 publications

(12 citation statements)

References 26 publications

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“…Huang et al. showed that patients submitted to a brainstem Dmax <67.4 Gy had a significantly lower risk of developing brainstem injury than those with a Dmax ≥67.4 Gy (OR = 25.29, 95% CI: 8.63–74.14; P < 0.001) ( 41 ); indicating that a brainstem Dmax <67.4 Gy can be safe and effective for patients with NPC receiving IMRT treatment. Taken together, these data suggest that the radiation tolerance of these intracranial structures should be reassessed for IMRT treatment planning.…”

Section: Discussionmentioning

confidence: 99%

Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy

Zhang

et al. 2021

Front. Oncol.

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ObjectiveWhether the original dosimetric constraints of neuro-optic structures (NOS) are appropriate for patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiotherapy (IMRT) remains controversial. The present study compared the survival rates and radiation-induced optic neuropathy (RION) occurrence between T4 NPC patients whose NOS were irradiated with a near maximum dose received by 2% of the volume (D2%) >55 Gy and ≤55 Gy. Moreover, the NOS dosimetric parameters and their correlation with RION occurrence were also evaluated.MethodsIn this retrospective study, 256 T4 NPC patients treated with IMRT between May 2009 and December 2013 were included. Patient characteristics, survival rates, dosimetric parameters, and RION incidence were compared between the D2% ≤55 Gy and D2% >55 Gy groups.ResultsThe median follow-up durations were 87 and 83 months for patients in the D2% >55 Gy and D2% ≤55 Gy groups, respectively. The 5-year local recurrence-free survival rates were 92.0 and 84.0% in the D2% >55 Gy and D2% ≤55 Gy groups (P = 0.043), respectively. There was no significant difference in the 5-year overall survival (OS) between both groups (D2% >55 Gy, 81.6%; D2% ≤55 Gy, 79.4%; P = 0.586). No patients developed severe RION (Grades 3–5), and there was no significant difference (P = 0.958) in the incidence of RION between the two groups. The maximum dose of NOS significantly affected the RION incidence, with a cutoff point of 70.77 Gy.ConclusionAppropriately loosening NOS dosimetric constraints in order to ensure a more sufficient dose to the target volume can provide a better 5-year local recurrence-free survival and acceptable neuro-optic toxicity in T4 NPC patients undergoing IMRT.

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Section: Discussionmentioning

confidence: 99%

Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy

Zhang

et al. 2021

Front. Oncol.

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“…RBN is a serious complication of intracranial and skull base tumors after radiotherapy. Previous studies included data on the frequency of RBN after irradiation of nasopharyngeal carcinoma (NPC), glioma, brain metastases, and intracranial arteriovenous malformations and are summarized in Table 1 [6][7][8][9][10][11][12][13][14][15]. Ruben et al [15] have reported that adjuvant chemotherapy after radiotherapy increased the incidence of RBN by a factor of five.…”

Section: Epidemiologymentioning

confidence: 99%

Treatment of Radiation‐Induced Brain Necrosis

Yang

Ren

Fei

2021

Oxidative Medicine and Cellular Longevity

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Radiation-induced brain necrosis (RBN) is a serious complication of intracranial as well as skull base tumors after radiotherapy. In the past, due to the lack of effective treatment, radiation brain necrosis was considered to be progressive and irreversible. With better understanding in histopathology and neuroimaging, the occurrence and development of RBN have been gradually clarified, and new treatment methods are constantly emerging. In recent years, some scholars have tried to treat RBN with bevacizumab, nerve growth factor, and gangliosides and have achieved similar results. Some cases of brain necrosis can be repairable and reversible. We aimed to summarize the incidence, pathogenesis, and treatment of RBN.

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“…Yet, several studies have reported that the incidenceof RIBN can be significantly reduced when using IMRT. For example, a retrospective study showed that only 0.13–2.8% [ 10 – 12 ] of patients with NPC developed brainstem necrosis after IMRT. RIBN is a late complication with low incidence but still worth of attention.…”

Section: Introductionmentioning

confidence: 99%

“…In the IMRT era, radiotherapist are usually confused by the tolerance dose of the brainstem, while the dose limit of conformal radiotherapy for the brainstem has been well-established [ 13 ]. Huang et.al reported a total of 24 BSI in 6288 patients who underwent IMRT and suggested a Dmax of 67.4 Gy (D2) as the dose constraint for brain stem [ 12 ]. However, the author also admitted that this was not ideal because it had relatively poor positive predictive value [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Huang et.al reported a total of 24 BSI in 6288 patients who underwent IMRT and suggested a Dmax of 67.4 Gy (D2) as the dose constraint for brain stem [ 12 ]. However, the author also admitted that this was not ideal because it had relatively poor positive predictive value [ 12 ]. Thus, we obtained the dose-volume data for organ at risk(OAR) from the treatment planning system and re-evaluated the tolerance dose of brainstem in IMRT era based on data in our institution.…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric analysis of radiation-induced brainstem necrosis for nasopharyngeal carcinoma treated with IMRT

Xue

Huang

et al. 2022

BMC Cancer

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Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Results Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively. Conclusions Brainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. Dmax of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.

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Evolution and Dosimetric Analysis of Magnetic Resonance Imaging–Detected Brain Stem Injury After Intensity Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Cited by 13 publications

References 26 publications

Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy

Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy

Treatment of Radiation‐Induced Brain Necrosis

Dosimetric analysis of radiation-induced brainstem necrosis for nasopharyngeal carcinoma treated with IMRT

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