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Anatomical changes in resection cavity during brain radiotherapy

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Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background and purpose

Brain tumors are in general treated with a maximal safe resection followed by radiotherapy of remaining tumor including the resection cavity (RC) and chemotherapy. Anatomical changes of the RC during radiotherapy can have impact on the coverage of the target volume. The aim of the current study was to quantify the potential changes of the RC and to identify risk factors for RC changes.

Materials and methods

Sixteen patients treated with pencil beam scanning proton therapy between October 2019 and April 2020 were retrospectively analyzed. The RC was delineated on pre-treatment computed tomography (CT) and magnetic resonance imaging, and weekly CT-scans during treatment. Isotropic expansions were applied to the pre-treatment RC (1–5 mm). The percentage of volume of the RC during treatment within the expanded pre-treatment volumes was quantified. Potential risk factors (volume of RC, time interval surgery-radiotherapy and relationship of RC to the ventricles) were evaluated using Spearman’s rank correlation coefficient.

Results

The average variation in relative RC volume during treatment was 26.1% (SD 34.6%). An expansion of 4 mm was required to cover > 95% of the RC volume in > 90% of patients. There was a significant relationship between the absolute volume of the pre-treatment RC and the volume changes during treatment (Spearman’s ρ = − 0.644; p = 0.007).

Conclusion

RCs are dynamic after surgery. Potentially, an additional margin in brain cancer patients with an RC should be considered, to avoid insufficient target coverage. Future research on local recurrence patterns is recommended.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CBCT:

Cone-beam computed tomography

CT:

Computed tomography

CTV:

Clinical target volume

EORTC:

European Organization for Research and Treatment of Cancer

FLAIR:

Fluid-attenuated inversion recovery

GTV:

Gross tumor volume

LGGs:

Low-grade glioma

MRI:

Magnetic resonance imaging

MR-IGRT:

Magnetic resonance image-guided radiotherapy

OARs:

Organs-at-risk

pCT:

Pre-treatment computed tomography scan

pMRI:

Pre-treatment magnetic resonance imaging scan

RC:

Resection cavity

reCT:

Repeat computed tomography scan

SRT:

Stereotactic radiotherapy

WHO:

World Health Organization

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Funding

This publication is part of the project “Making radiotherapy sustainable” with project number 10070012010002 of the Highly Specialised Care and Research programme (TZO programme) which is (partly) financed by the Netherlands Organisation for Health Research and Development (ZonMw).

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Author notes

  1. Yves C. P. Willems and Femke Vaassen are joint first authors, having contributed equally to the writing of this manuscript.

Authors and Affiliations

  1. Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Yves C. P. Willems, Femke Vaassen, Catharina M. L. Zegers, Mirko Unipan, Ans Swinnen, Inge Compter, Wouter van Elmpt & Daniëlle B. P. Eekers

  2. Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Alida A. Postma

  3. Department of Radiation Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

    Jaap Jaspers & Alejandra Méndez Romero

  4. Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Monique Anten

  5. Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Onno Teernstra

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Contributions

YW and FV are joint first authors, having contributed equally to the writing of this manuscript. CZ, MU, AS and WE helped with interpretation of the data and review of the manuscript. DE and IC have delineated the GTVs and CTVs for this study, helped with interpretation of the data, and supervised the research. AP, JJ, AR, MA and OT performed critical review of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Femke Vaassen.

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Competing interests

The authors declare that they have no competing interests.

Ethical approval

This research was submitted to the Internal Review Board of the department of radiation oncology Maastricht (Maastro).

Informed consent

Only retrospective and anonymized data were used, therefore informed consent was waived (reference number P0407; W 20 02 00044).

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Not applicable.

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Willems, Y.C.P., Vaassen, F., Zegers, C.M.L. et al. Anatomical changes in resection cavity during brain radiotherapy. J Neurooncol 165, 479–486 (2023). https://doi.org/10.1007/s11060-023-04505-1

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