Significance of target location relative to the depth from the brain surface and high-dose irradiated volume in the development of brain radionecrosis after micromultileaf collimator-based stereotactic radiosurgery for brain metastases

J Neurooncol. 2012 May;108(1):201-9. doi: 10.1007/s11060-012-0834-3. Epub 2012 Mar 6.

Abstract

The objective of this study was to investigate the factors that potentially lead to brain radionecrosis (RN) after micromultileaf collimator-based stereotactic radiosurgery (SRS) for brain metastases. We retrospectively evaluated 131 lesions with a minimum follow-up of 6 months, 43.5% of which received prior whole-brain radiotherapy (WBRT). The three-tiered location grade (LG) was defined, as follows, for each target by considering mainly the depth from the brain surface: grade 1 (superficial), involving the region at a depth of ≤5 mm from the brain surface; grade 2 (deep), located at a depth of >5 mm from the brain surface; and grade 3 (central), located in the brainstem, cerebellar peduncle, diencephalon, or basal ganglion. The predictive factors for RN, including high-dose irradiated isodose volumes (IIDVs) and LG, were evaluated by univariate and multivariate analysis. Symptomatic RN (S-RN) and asymptomatic RN (A-RN) were observed in 8.4% and 6.9% of cases, respectively. Multivariate analysis indicated that the significant factors for both types of RN were LG, V12 Gy, and V22 Gy in all cases; V22 Gy and LG for the non-WBRT cases; and V15 Gy and LG for the WBRT cases. For the non-WBRT cases, the cutoff values of V22 Gy were 2.62 and 2.14 cm(3) for S-RN and both RN, respectively. For the WBRT cases, the cutoff values of V15 Gy were 5.61 and 5.20 cm(3) for S-RN and both RN, respectively. In addition to the IIDV data, LG helps predict the risk of RN. High-dose IIDV, V22 Gy, was also significantly correlated with RN, particularly for patients treated with SRS alone.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Area Under Curve
  • Brain / pathology*
  • Brain Neoplasms / drug therapy
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Necrosis
  • ROC Curve
  • Radiation Injuries / etiology*
  • Radiation Injuries / pathology*
  • Radiosurgery / adverse effects*
  • Radiotherapy Dosage
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Antineoplastic Agents