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Radiation sparing of cerebral cortex in brain tumor patients using quantitative neuroimaging.

  • Author(s): Karunamuni, Roshan A
  • Moore, Kevin L
  • Seibert, Tyler M
  • Li, Nan
  • White, Nathan S
  • Bartsch, Hauke
  • Carmona, Ruben
  • Marshall, Deborah
  • McDonald, Carrie R
  • Farid, Nikdokht
  • Krishnan, Anithapriya
  • Kuperman, Joshua
  • Mell, Loren K
  • Brewer, James
  • Dale, Anders M
  • Moiseenko, Vitali
  • Hattangadi-Gluth, Jona A
  • et al.
Abstract

Neurocognitive decline in brain tumor patients treated with radiotherapy (RT) may be linked to cortical atrophy. We developed models to determine radiation treatment-planning objectives for cortex, which were tested on a sample population to identify the dosimetric cost of cortical sparing.The relationship between the probability of cortical atrophy in fifteen high-grade glioma patients at 1-year post-RT and radiation dose was fit using logistic mixed effects modeling. Cortical sparing was implemented using two strategies: region-specific sparing using model parameters, and non-specific sparing of all normal brain tissue.A dose threshold of 28.6 Gy was found to result in a 20% probability of severe atrophy. Average cortical sparing at 30 Gy was greater for region-specific dose avoidance (4.6%) compared to non-specific (3.6%). Cortical sparing resulted in an increase in heterogeneity index of the planning target volume (PTV) with an average increase of 1.9% (region-specific) and 0.9% (non-specific).We found RT doses above 28.6 Gy resulted in a greater than 20% probability of cortical atrophy. Cortical sparing can be achieved using region-specific or non-specific dose avoidance strategies at the cost of an increase in the dose heterogeneity of the PTV.

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