Stefania Volpe1,2, Pierre-Yves Bondiau3, Line Claude4, Audrey Claren3, Laetitia Padovani5, Hamza AlGhamdi3,6, Gwenaëlle Duhil De Benaze7, Lucas Opitz8, Guillaume Baudin9, Catherine Dejean3, Daniel Maneval3, Barbara Alicja Jereczek-Fossa10,11, Jérôme Doyen12. 1. Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy. stefania.volpe@ieo.it. 2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. stefania.volpe@ieo.it. 3. Antoine Lacassagne Centre, Department of Radiation Oncology, Fédération Claude-Lalanne, University of Côte d'Azur, Nice, France. 4. Department of Radiation Oncology, Léon Bérard Centre, Lyon, France. 5. Oncology Radiotherapy Department, CRCM Inserm, UMR1068, CNRS UMR7258, AMU UM105, Genome Instability and Carcinogenesis, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 6. Oncology Center, King Faisal Medicao City for Southern Region, Abha, Saudi Arabia. 7. Pedatric Oncology, Archet Hospital, Nice, France. 8. Antoine-Lacassagne Centre, Department of Anesthesiology, University of Côte d'Azur, Nice, France. 9. Antoine-Lacassagne Centre, Department of Radiology, University of Côte d'Azur, Nice, France. 10. Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy. 11. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. 12. Antoine Lacassagne Centre, Department of Radiation Oncology, Fédération Claude-Lalanne, University of Côte d'Azur, Nice, France. jerome.doyen@nice.unicancer.fr.
Abstract
PURPOSE: Brainstem radionecrosis is an important issue during the irradiation of tumors of the posterior fossa. The aim of the present study is to analyze postsurgical geometrical variations of tumor bed (TB) and brainstem (BS) and their impact on dosimetry. METHODS: Retrospective collection of data from pediatric patients treated at a single institution. Availability of presurgical magnetic resonance imaging (MRI) was verified; availability of at least two postsurgical MRIs was considered a further inclusion criterion. The following metrics were analyzed: total volume, Dice similarity coefficient (DSC), and Haudsdorff distances (HD). RESULTS: Fourteen patients were available for the quantification of major postsurgical geometrical variations of TB. DSC, HD max, and HD average values were 0.47 (range: 0.08;0.76), 11.3 mm (7.7;24.5), and 2.6 mm (0.7;6.7) between the first and the second postoperative MRI, respectively. Postsurgical geometrical variations of the BS were also observed. Coverage to the TB was reduced in one patient (D95: -2.9 Gy), while D2 to the BS was increased for the majority of patients. Overall, predictive factors for significant geometrical changes were presurgical gross tumor volume (GTV) > 33 mL, hydrocephaly at diagnosis, Luschka foramen involvement, and younger age (≤ 8 years). CONCLUSION: Major volume changes were observed in this cohort, with some dosimetric impact. The use of a recent co-registration MRI is advised. The 2-3 mm HD average observed should be considered in the planning target volume/planning organ at risk volume (PTV/PRV) margin and/or robust optimization planning. Results from wider efforts are needed to verify our findings.
PURPOSE: Brainstem radionecrosis is an important issue during the irradiation of tumors of the posterior fossa. The aim of the present study is to analyze postsurgical geometrical variations of tumor bed (TB) and brainstem (BS) and their impact on dosimetry. METHODS: Retrospective collection of data from pediatric patients treated at a single institution. Availability of presurgical magnetic resonance imaging (MRI) was verified; availability of at least two postsurgical MRIs was considered a further inclusion criterion. The following metrics were analyzed: total volume, Dice similarity coefficient (DSC), and Haudsdorff distances (HD). RESULTS: Fourteen patients were available for the quantification of major postsurgical geometrical variations of TB. DSC, HD max, and HD average values were 0.47 (range: 0.08;0.76), 11.3 mm (7.7;24.5), and 2.6 mm (0.7;6.7) between the first and the second postoperative MRI, respectively. Postsurgical geometrical variations of the BS were also observed. Coverage to the TB was reduced in one patient (D95: -2.9 Gy), while D2 to the BS was increased for the majority of patients. Overall, predictive factors for significant geometrical changes were presurgical gross tumor volume (GTV) > 33 mL, hydrocephaly at diagnosis, Luschka foramen involvement, and younger age (≤ 8 years). CONCLUSION: Major volume changes were observed in this cohort, with some dosimetric impact. The use of a recent co-registration MRI is advised. The 2-3 mm HD average observed should be considered in the planning target volume/planning organ at risk volume (PTV/PRV) margin and/or robust optimization planning. Results from wider efforts are needed to verify our findings.
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