Outcomes and patterns of radiation associated brain image changes after proton therapy for head and neck skull base cancers.
Brain necrosis
Dose–response relationship
Head and neck cancer
MR image change
Radiation Injuries
Skull base, Proton therapy
Journal
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
10
03
2020
revised:
01
07
2020
accepted:
03
07
2020
pubmed:
18
7
2020
medline:
15
4
2021
entrez:
18
7
2020
Statut:
ppublish
Résumé
To characterize patterns and outcomes of brain MR image changes after proton therapy (PT) for skull base head and neck cancer (HNC). Post-treatment MRIs ≥6 months were reviewed for radiation-associated image changes (RAIC) in 127 patients. All patients had received at least a point dose of 40 Gy(RBE) to the brain. The MRIs were rigidly registered to planning CTs and RAIC lesions were contoured both on T1 weighted (post-contrast) and T2 weighted sequences, and dose-volume parameters extracted. Probability of RAIC was calculated using multistate survival analysis. Univariate/multivariate analyses were performed using Cox Regression. Recursive partitioning analysis was used to investigate dose-volume correlates of RAIC development. 17.3% developed RAIC. All RAIC events were asymptomatic and occurred in the temporal lobe (14), frontal lobe (6) and cerebellum (2). The median volume of the contrast enhanced RAIC lesion was 0.5 cc at their maximum size. The RAIC resolved or improved in 45.5% of the patients and were stable or progressed in 36.4%. The 3-year actuarial rate of developing RAIC was 14.3%. RAIC was observed in 63% of patients when V Small RAIC lesions after PT occurred in 17.3% of the patients; the majority in nasopharyngeal or sinonasal cancer. The estimated dose-volume correlations confirm the importance of minimizing focal high doses to brain when achievable.
Sections du résumé
BACKGROUND AND PURPOSE
To characterize patterns and outcomes of brain MR image changes after proton therapy (PT) for skull base head and neck cancer (HNC).
MATERIAL AND METHODS
Post-treatment MRIs ≥6 months were reviewed for radiation-associated image changes (RAIC) in 127 patients. All patients had received at least a point dose of 40 Gy(RBE) to the brain. The MRIs were rigidly registered to planning CTs and RAIC lesions were contoured both on T1 weighted (post-contrast) and T2 weighted sequences, and dose-volume parameters extracted. Probability of RAIC was calculated using multistate survival analysis. Univariate/multivariate analyses were performed using Cox Regression. Recursive partitioning analysis was used to investigate dose-volume correlates of RAIC development.
RESULTS
17.3% developed RAIC. All RAIC events were asymptomatic and occurred in the temporal lobe (14), frontal lobe (6) and cerebellum (2). The median volume of the contrast enhanced RAIC lesion was 0.5 cc at their maximum size. The RAIC resolved or improved in 45.5% of the patients and were stable or progressed in 36.4%. The 3-year actuarial rate of developing RAIC was 14.3%. RAIC was observed in 63% of patients when V
CONCLUSION
Small RAIC lesions after PT occurred in 17.3% of the patients; the majority in nasopharyngeal or sinonasal cancer. The estimated dose-volume correlations confirm the importance of minimizing focal high doses to brain when achievable.
Identifiants
pubmed: 32679304
pii: S0167-8140(20)30401-1
doi: 10.1016/j.radonc.2020.07.008
pmc: PMC7674217
mid: NIHMS1630942
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
119-125Subventions
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Organisme : NIDCR NIH HHS
ID : R01 DE025248
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA214825
Pays : United States
Organisme : NIBIB NIH HHS
ID : R25 EB025787
Pays : United States
Organisme : NIDCR NIH HHS
ID : R56 DE025248
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA218148
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA225190
Pays : United States
Organisme : NCI NIH HHS
ID : P50 CA097007
Pays : United States
Organisme : NIDCR NIH HHS
ID : R01 DE028290
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.