Leukoencephalopathy After Stereotactic Radiosurgery for Brain Metastases

Trifiletti, Daniel M.; Lee, Cheng‐Chia; Schlesinger, David; Larner, James M.; Xu, Zhiyuan; Sheehan, Jason P.

doi:10.1016/j.ijrobp.2015.07.2280

Cited by 36 publications

(25 citation statements)

References 59 publications

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“…In our study, the integral dose to the brain exceeded 3 J (a value deemed as a threshold for significant risk of LE by Trifiletti et al [9]) when the total tumor volume exceeded 25 cm 3 . Both the plan conformity and gradient indices had a significant influence on the integral dose to brain tissue as well.…”

Section: Resultsmentioning

confidence: 54%

“…One explanation for this is the volume-dependent decrease in prescription dose in patients with larger or more numerous tumors. It is unclear why the total treated tumor volume did not correlate with LE in the study by Trifiletti et al [9]. …”

Section: Discussionmentioning

confidence: 95%

“…Trifiletti et al [9] reported that LE was associated with an increased number of brain lesions, but not with the total brain volume treated. However, 30% of the 103 patients included in their study had prior WBRT, which could have had a confounding effect on their data since there is no way to isolate those effects from those of the SRS.…”

Section: Discussionmentioning

confidence: 99%

“…Since patients with intracranial metastatic disease are living longer than ever before, these lasting adverse effects of treatment are of concern [8]. The risk of neurocognitive deficits from radiation is reported to be associated with the total volume of brain tissue treated [9], and therefore it is reasonable to predict that SRS for a small number of lesions would decrease the risk of these side effects. …”

Section: Introductionmentioning

confidence: 99%

“…A recent study by Trifiletti et al [9] investigated the risk factors for leukoencephalopathy (LE), and by default, neurocognitive decline, in patients treated with SRS for metastatic brain disease. The authors found that the use of WBRT, a higher SRS integral dose to the cranium, and the total number of intracranial metastases were all significantly associated with increased LE.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Number of Metastatic Tumors Treated by Stereotactic Radiosurgery on the Dose to Normal Brain: Implications for Brain Protection

Rivers¹,

Tranquilli²,

Prasad³

et al. 2017

Stereotact Funct Neurosurg

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Purpose/Objectives: The purpose of this study was to evaluate the effect of the number of brain lesions for which stereotactic radiosurgery (SRS) was performed on the dose volume relationships in normal brain. Materials and Methods: Brain tissue was segmented using the patient's pre-SRS MRI. For each plan, the following data points were recorded: total brain volume, number of lesions treated, volume of brain receiving 8 Gy (V8), V10, V12, and V15. Results: A total of 225 Gamma Knife® treatments were included in this retrospective analysis. The number of lesions treated ranged from 1 to 29. The isodose for prescription ranged from 40 to 95% (mean 55%). The mean prescription dose to tumor edge was 18 Gy. The mean coverage, selectivity, conformity, and gradient index were 97.5%, 0.63, 0.56, and 3.5, respectively. The mean V12 was 9.5 cm³ (ranging from 0.5 to 59.29). There was no correlation between the number of lesions and brain V8, V12, V10, or V15. There was a direct and statistically significant relationship between the brain volume treated (V8, V10, V12, and V15) and total volume of tumors treated (p < 0.001). In our study, the integral dose to the brain exceeded 3 J when the total tumor volume exceeded 25 cm³. Conclusions: The number of metastatic brain lesions treated bears no significant relationship to total brain tissue volume treated when using SRS. The fact that the integral dose to the brain exceeded 3 J when the total tumor volume exceeded 25 cm³ is useful for establishing guidelines. Although standard practice has favored using whole brain radiation therapy in patients with more than 4 lesions, a significant amount of normal brain tissue may be spared by treating these patients with SRS. SRS should be carefully considered in patients with multiple brain lesions, with the emphasis on total brain volume involved rather than the number of lesions to be treated.

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Section: Resultsmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations