Irradiated Volume as a Predictor of Brain Radionecrosis After Linear Accelerator Stereotactic Radiosurgery
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH (United States)
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH (United States)
Purpose: To investigate the correlation between volume of brain irradiated by stereotactic radiosurgery (SRS) and the incidence of symptomatic and asymptomatic brain radionecrosis (RN). Methods and Materials: A retrospective analysis was performed of patients treated with single-fraction SRS for brain metastases at our institution. Patients with at least 6-month imaging follow-up were included and diagnosed with RN according to a combination of criteria, including appearance on serial imaging and histology. Univariate and multivariate analyses were performed to determine the predictive value of multiple variables, including volume of brain receiving a specific dose (V8 Gy-V18 Gy). Results: Sixty-three patients were reviewed, with a total of 173 lesions. Most patients (63%) had received previous whole-brain irradiation. Mean prescribed SRS dose was 18 Gy. Symptomatic RN was observed in 10% and asymptomatic RN in 4% of lesions treated. Multivariate regression analysis showed V8 Gy-V16 Gy to be most predictive of symptomatic RN (p < 0.0001). Threshold volumes for significant rise in RN rates occurred between the 75th and 90th percentiles, with a midpoint volume of 10.45 cm{sup 3} for V10 Gy and 7.85 cm{sup 3} for V12 Gy. Conclusions: Analysis of patient and treatment variables revealed V8 Gy-V16 Gy to be the best predictors for RN using linear accelerator-based single-fraction SRS for brain metastases. We propose that patients with V10 Gy >10.5 cm{sup 3} or V12 Gy >7.9 cm{sup 3} be considered for hypofractionated rather than single-fraction treatment, to minimize the risk of symptomatic RN.
- OSTI ID:
- 21436063
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 77, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2009.06.006; PII: S0360-3016(09)00856-6; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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