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Postsurgical geometrical variations of tumor bed and brainstem during photon and proton therapy for pediatric tumors of the posterior fossa: dosimetric impact and predictive factors

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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.

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Abbreviations

BS:

Brainstem

CNS:

Central nervous system

CT:

Computed tomography

CTV:

Clinical target volume

DICOM:

Digital Imaging and Communication in Medicine

DSC:

Dice similarity coefficient

EPTN:

European Particle Therapy Network

GTV:

Gross tumor volume

HD:

Hausdorff distance

IQR:

Interquartile range

LET:

Linear energy transfer

MRI:

Magnetic resonance imaging

NTCP:

Normal tissue complication probability

OAR:

Organ at risk

PF:

Posterior fossa

PRV:

Planning organ at risk volume

PT:

Proton therapy

PTV:

Planning target volume

ROI:

Region of interest

RT:

Radiotherapy

RBE:

Relative biological effectiveness

SOBP:

Spread-out Bragg peak

TB:

Tumor bed

TPS:

Treatment planning system

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Acknowledgements

Stefania Volpe MD was partially supported by the Italian Ministry of Health with Progetto di Eccellenza, and is a PhD student within the European School of Molecular Medicine (SEMM).

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Authors and Affiliations

  1. Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy

    Stefania Volpe M.D. & Barbara Alicja Jereczek-Fossa M.D., Ph.D.

  2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Stefania Volpe M.D. & Barbara Alicja Jereczek-Fossa M.D., Ph.D.

  3. Antoine Lacassagne Centre, Department of Radiation Oncology, Fédération Claude-Lalanne, University of Côte d’Azur, Nice, France

    Pierre-Yves Bondiau M.D., Ph.D., Audrey Claren M.D., M.Sc., Hamza AlGhamdi M.D., Catherine Dejean PhD, Daniel Maneval Ph.D. & Jérôme Doyen M.D., Ph.D.

  4. Department of Radiation Oncology, Léon Bérard Centre, Lyon, France

    Line Claude M.D.

  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

    Laetitia Padovani M.D., Ph.D.

  6. Oncology Center, King Faisal Medicao City for Southern Region, Abha, Saudi Arabia

    Hamza AlGhamdi M.D.

  7. Pedatric Oncology, Archet Hospital, Nice, France

    Gwenaëlle Duhil De Benaze M.D.

  8. Antoine-Lacassagne Centre, Department of Anesthesiology, University of Côte d’Azur, Nice, France

    Lucas Opitz M.D.

  9. Antoine-Lacassagne Centre, Department of Radiology, University of Côte d’Azur, Nice, France

    Guillaume Baudin M.D.

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  1. Stefania Volpe M.D.
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  2. Pierre-Yves Bondiau M.D., Ph.D.
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  3. Line Claude M.D.
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Correspondence to Stefania Volpe M.D. or Jérôme Doyen M.D., Ph.D..

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Conflict of interest

S. Volpe, P.-Y. Bondiau, L. Claude, A. Claren, L. Padovani, H. AlGhamdi, G. Duhil De Benaze, L. Opitz, G. Baudin, C. Dejean, D. Maneval, B.A. Jereczek-Fossa, and J. Doyen declare that they have no competing interests.

Additional information

J. Doyen is the author responsible for the statistical analysis.

Supplementary Information

Table S1:

Gross tumor volume extension—anatomical details

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Volpe, S., Bondiau, PY., Claude, L. et al. Postsurgical geometrical variations of tumor bed and brainstem during photon and proton therapy for pediatric tumors of the posterior fossa: dosimetric impact and predictive factors. Strahlenther Onkol 197, 1113–1123 (2021). https://doi.org/10.1007/s00066-021-01828-8

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