Grete May Engeseth1, Sonja Stieb2, Abdallah Sherif Radwan Mohamed3, Renjie He4, Camilla Hanquist Stokkevåg5, Marianne Brydøy6, Clifton Dave Fuller7, Adam S Garden8, David I Rosenthal9, Jack Phan10, William H Morrison11, Jay P Reddy12, Richard Wu13, Xiaodong Zhang14, Steven Jay Frank15, Gary Brandon Gunn16. 1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA; Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway; Department of Physics and Technology, University of Bergen, Norway. Electronic address: grete.may.engeseth@helse-bergen.no. 2. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: SMStieb@mdanderson.org. 3. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: ASMohamed@mdanderson.org. 4. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: RHe1@mdanderson.org. 5. Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway. Electronic address: hanquist.stokkevag@helse-bergen.no. 6. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: marianne.brydoy@helse-bergen.no. 7. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: CDFuller@mdanderson.org. 8. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: agarden@mdanderson.org. 9. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: dirosenthal@mdanderson.org. 10. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: jphan@mdanderson.org. 11. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: whmorrison@mdanderson.org. 12. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: JReddy@mdanderson.org. 13. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: rywu@mdanderson.org. 14. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: xizhang@mdanderson.org. 15. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: sjfrank@mdanderson.org. 16. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: GBGunn@mdanderson.org.
Abstract
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 V67 Gy(RBE) of the brain ≥0.17 cc. 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.
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 V67 Gy(RBE) of the brain ≥0.17 cc. 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.
Authors: Helge Henjum; Tordis J Dahle; Lars Fredrik Fjæra; Eivind Rørvik; Sara Pilskog; Camilla H Stokkevåg; Andrea Mairani; Kristian S Ytre-Hauge Journal: Adv Radiat Oncol Date: 2021-08-17
Authors: G Brandon Gunn; Adam S Garden; Rong Ye; Noveen Ausat; Kristina R Dahlstrom; William H Morrison; C David Fuller; Jack Phan; Jay P Reddy; Shalin J Shah; Lauren L Mayo; Stephen G Chun; Gregory M Chronowski; Amy C Moreno; Jeffery N Myers; Ehab Y Hanna; Bita Esmaeli; Maura L Gillison; Renata Ferrarotto; Katherine A Hutcheson; Mark S Chambers; Lawrence E Ginsberg; Adel K El-Naggar; David I Rosenthal; Xiaorong Ronald Zhu; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25