立体定向放射外科治疗脑干转移瘤和动静脉瘤毒性的剂量学预测：一项国际、多机构分析。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-02-19 DOI:10.1016/j.radonc.2025.110795

Raj Singh , Samantha Dayawansa , Duy Pham , Georgios Mantziaris , Selcuk Peker , Yavuz Samanci , Ali Haluk Duzkalir , David Mathieu , Anne-Marie Langlois , Molly L. Egnot , Ronald E. Warnick , Herwin Speckter , Erwin Lazo , Laura Mendez , Angel I. Blanco , Mark J. Amsbaugh , Collin Liu , Andrea Becerril-Gaitan , Yoshua Esquenazi , Ching-Jen Chen , Jason P. Sheehan

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引用次数: 0

摘要

背景：关于单次立体定向放射手术（SRS）后脑干转移或动静脉畸形（AVMs）放射诱导改变（RICs）的剂量学预测数据有限。方法：我们对接受SRS治疗的脑干转移或avm患者进行了多机构队列研究。我们评估了根据CTCAE（不良事件通用术语标准）分级的RICs预测因子，包括D5%、D95%、D0.03 cc和D0.5 cc（脑干减病变）。最初进行单变量逻辑回归，并在多变量逻辑回归中纳入趋向显著的自变量。结果：共分析了124例脑干病变（21例AVMs， 103例转移）。处方中位剂量为16 Gy（范围：13-23 Gy），中位治疗量为0.48 cc（范围：0.002-11.19 cc）。RICs的发生率为9.7% %（3/12为3-4级，无5级）。所有病例均发生在脑干转移，中脑-脑桥转移无一例。治疗量 ≥ 1cc与症状性RIC发生率增高相关(6/57 vs 6/65； = 0.04页)。值得注意的是，所有RIC病例的D0.5 cc ≥ 15 Gy（12/87 vs. 0/32）。D5%≥6 Gy(9/55 vs. 3/69；p = 0.04),D95%≥1 Gy(7/31 vs. 5/93；p = 0.01)与较高的RICs发生率显著相关，D0.03 cc ≥ 22 Gy与较低的风险相关(2/61 vs. 9/63； = 0.03页)。在MVA上，D0.03 cc ≥ 22 Gy仍然是RICs发生率较低的重要预测因子(优势比 = -1.72(95 % CI: -3.32至-0.12； = 0.04页)。结论：脑干转移瘤和avm的SRS后RICs的发生率较低。我们建议优化D0.5 cc的放疗计划

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Dosimetric predictors of toxicity for brainstem metastases and AVMs treated with stereotactic radiosurgery: An international, multi-institutional analysis

Background

There are limited data on dosimetric predictors of radiation-induced changes (RICs) for brainstem metastases or arteriovenous malformations (AVMs) following single-fraction stereotactic radiosurgery (SRS).

Methods

We examined a multi-institutional cohort of patients with brainstem metastases or AVMs treated with SRS. We evaluated predictors of RICs graded per CTCAE(Common Terminology Criteria for Adverse Events), including D5%, D95%, D0.03 cc, and D0.5 cc (brainstem minus lesion). Univariate logistic regressions were initially performed with independent variables trending towards significance included on multivariate logistic regression.

Results

A total of 124 brainstem lesions treated with SRS were analyzed (21 AVMs and 103 metastases). The median prescription dose was 16 Gy(range: 13–23 Gy), and the median treatment volume was 0.48 cc(range: 0.002–11.19 cc). The incidence of RICs was 9.7 % (with 3/12 being Grade 3–4 and no Grade 5). All cases occurred in brainstem metastases, with no cases among those of the midbrain-pons transition. Treatment volumes ≥ 1cc were correlated with a higher symptomatic RIC incidence(6/57 vs. 6/65; p = 0.04). Notably, all RIC cases had a D0.5 cc ≥ 15 Gy(12/87 vs. 0/32). Both D5%≥6 Gy(9/55 vs. 3/69; p = 0.04) and D95%≥1 Gy(7/31 vs. 5/93; p = 0.01) were significantly correlated with higher incidence of RICs and D0.03 cc ≥ 22 Gy was correlated with a lower risk(2/61 vs. 9/63; p = 0.03). On MVA, D0.03 cc ≥ 22 Gy remained a significant predictor of a lower incidence of RICs(odds ratio = -1.72 (95 % CI: −3.32 to −0.12; p = 0.04).

Conclusions

Incidence of RICs was low following SRS for brainstem metastases and AVMs. We recommend optimizing radiosurgical plans for D0.5 cc < 15 Gy with consideration of D5% and D95%, with less emphasis on D0.03 cc to allow to meet the former metrics as feasible.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.