Intracranial Autograft Fat Placement to Separate the Optic Chiasm from Tumor to Improve Stereotactic Radiotherapy Dosimetry.
Abdominal Fat
/ transplantation
Adult
Autografts
Brain Neoplasms
/ radiotherapy
Chondrosarcoma
/ radiotherapy
Female
Humans
Male
Meningeal Neoplasms
/ radiotherapy
Meningioma
/ radiotherapy
Neoplasm Recurrence, Local
/ radiotherapy
Optic Chiasm
/ radiation effects
Organs at Risk
Radiation Injuries
/ prevention & control
Radiometry
Radiosurgery
/ methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
/ methods
Fat
Hypophysopexy
Optic nerve
Radiosurgery
Spacer
Tolerance
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
27
06
2020
revised:
19
10
2020
accepted:
20
10
2020
pubmed:
2
11
2020
medline:
22
6
2021
entrez:
1
11
2020
Statut:
ppublish
Résumé
Radiation therapy for intracranial lesions is constrained by dose to neurologic organs at risk. We report 2 cases, a newly diagnosed chondrosarcoma and a previously irradiated meningioma, with tumors that abutted the optic chiasm following subtotal resection. Definitive radiotherapy would have required either undercoverage of the tumor or treatment of the chiasm with doses posing an unacceptable risk of blindness. Therefore, the patients underwent open surgery with placement of an abdominal fat autograft to provide space between the tumor and the optic structures at risk. Patients received definitive fractionated stereotactic radiotherapy. For each patient, we retrospectively compared the treated plan (with fat autograft) to a second plan generated using the pre-autograft imaging, maintaining similar tumor coverage. For the chondrosarcoma, the fat autograft reduced the optic chiasm maximum dose by 21% (70.4 Gy to 55.3 Gy). For the reirradiated peri-optic meningioma, the optic chiasm maximum dose was reduced by 10% (50.8 Gy to 45.9 Gy), the left optic nerve by 17% (48.9 Gy to 40.4 Gy), and the right optic nerve by 30% (32.3 Gy to 22.6 Gy). We demonstrate the utility of abdominal fat autograft placement to maximize coverage of tumor while minimizing dose to intracranial organs at risk.
Sections du résumé
BACKGROUND
Radiation therapy for intracranial lesions is constrained by dose to neurologic organs at risk.
CASE DESCRIPTION
We report 2 cases, a newly diagnosed chondrosarcoma and a previously irradiated meningioma, with tumors that abutted the optic chiasm following subtotal resection. Definitive radiotherapy would have required either undercoverage of the tumor or treatment of the chiasm with doses posing an unacceptable risk of blindness. Therefore, the patients underwent open surgery with placement of an abdominal fat autograft to provide space between the tumor and the optic structures at risk. Patients received definitive fractionated stereotactic radiotherapy. For each patient, we retrospectively compared the treated plan (with fat autograft) to a second plan generated using the pre-autograft imaging, maintaining similar tumor coverage. For the chondrosarcoma, the fat autograft reduced the optic chiasm maximum dose by 21% (70.4 Gy to 55.3 Gy). For the reirradiated peri-optic meningioma, the optic chiasm maximum dose was reduced by 10% (50.8 Gy to 45.9 Gy), the left optic nerve by 17% (48.9 Gy to 40.4 Gy), and the right optic nerve by 30% (32.3 Gy to 22.6 Gy).
CONCLUSIONS
We demonstrate the utility of abdominal fat autograft placement to maximize coverage of tumor while minimizing dose to intracranial organs at risk.
Identifiants
pubmed: 33130141
pii: S1878-8750(20)32302-0
doi: 10.1016/j.wneu.2020.10.110
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
80-84Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.