PMID- 31075310
OWN - NLM
STAT- Publisher
LR  - 20190510
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
DP  - 2019 May 7
TI  - Evolution and Dosimetric Analysis of MRI-detected Brainstem Injury Following
      Intensity Modulated Radiotherapy in Nasopharyngeal Carcinoma.
LID - S0360-3016(19)30694-7 [pii]
LID - 10.1016/j.ijrobp.2019.04.032 [doi]
AB  - PURPOSE: To evaluate the evolution of radiation-induced brainstem injury (BSI) in
      nasopharyngeal-carcinoma (NPC) patients treated with intensity-modulated
      radiotherapy (IMRT) and to identify the critical dosimetric predictors of BSI.
      MATERIALS AND METHODS: A total of 6288 NPC patients treated with IMRT between
      2009 and 2015 were retrospectively reviewed. Among these 6288 patients 24 had
      radiation-induced BSI, manifesting as edematous lesions (ELs) and
      contrast-enhanced lesions (CLs) on magnetic resonance imaging (MRI). Latency,
      symptoms, and evolution of BSI were assessed. Critical dosimetric predictors of
      BSI were identified using a penalized regression model with performance evaluated
      by receiver operating curve (ROC) analysis. RESULTS: Median BSI latency was 14.5 
      months (range, 7.6-37.5 months), and 37.5% (9/24) of patients were clinically
      symptomatic. ELs and CLs were both present in all patients. Necrosis was
      significantly more common in larger CLs (P = 0.007). After median follow-up of
      12.5 months, 13/24 (54.2%) patients had complete remission and 5/24 (20.8%)
      patients had partial remission. Remission was unaffected by whether or not
      symptomatic treatment was given. Dmax was identified as the critical predictor of
      BSI (area under the ROC curve = 0.898), with the optimal cutoff equivalent dose
      in 2-Gy fractions (D2) being 67.4 Gy (sensitivity = 0.833, 20/24; specificity =
      0.835, 5234/6264). Patients with Dmax >/=67.4 Gy (D2) were significantly more
      likely to develop BSI (odds ratio = 25.29, 95% CI: 8.63-74.14; P < 0.001) than
      those with Dmax <67.4 Gy (D2). CONCLUSIONS: In NPC patients treated with IMRT BSI
      generally tends to improve over time. Dmax = 67.4 Gy (D2) appears to be the dose 
      constraint for brainstem, potentially providing clinicians with greater choice
      and flexibility when balancing the tumor target coverage and brainstem
      protection. Further studies are needed to validate our findings.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Huang, Xiao-Dan
AU  - Huang XD
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Li, Yang-Chan
AU  - Li YC
AD  - Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen
      University, Guangzhou 510080, People's Republic of China.
FAU - Chen, Fo-Ping
AU  - Chen FP
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Zheng, Wei-Hong
AU  - Zheng WH
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Zhou, Guan-Qun
AU  - Zhou GQ
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Lin, Li
AU  - Lin L
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Hu, Jiang
AU  - Hu J
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - He, Wen-Jun
AU  - He WJ
AD  - School of Public Health, Sun Yat-sen University, Guangzhou 510060, People's
      Republic of China.
FAU - Zhang, Lu-Lu
AU  - Zhang LL
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Kou, Jia
AU  - Kou J
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Ma, Jun
AU  - Ma J
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Zhang, Wei-Dong
AU  - Zhang WD
AD  - Department of Radiology, Cancer Center, Sun Yat-sen University, Guangzhou 510060,
      People's Republic of China.
FAU - Qi, Zhen-Yu
AU  - Qi ZY
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China.
FAU - Sun, Ying
AU  - Sun Y
AD  - State Key Laboratory of Oncology in Southern China, Collaborative Innovation
      Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun
      Yat-sen University, Guangzhou 510060, People's Republic of China. Electronic
      address: sunying@sysucc.org.cn.
LA  - eng
PT  - Journal Article
DEP - 20190507
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
EDAT- 2019/05/11 06:00
MHDA- 2019/05/11 06:00
CRDT- 2019/05/11 06:00
PHST- 2019/01/04 00:00 [received]
PHST- 2019/04/03 00:00 [revised]
PHST- 2019/04/27 00:00 [accepted]
PHST- 2019/05/11 06:00 [entrez]
PHST- 2019/05/11 06:00 [pubmed]
PHST- 2019/05/11 06:00 [medline]
AID - S0360-3016(19)30694-7 [pii]
AID - 10.1016/j.ijrobp.2019.04.032 [doi]
PST - aheadofprint
SO  - Int J Radiat Oncol Biol Phys. 2019 May 7. pii: S0360-3016(19)30694-7. doi:
      10.1016/j.ijrobp.2019.04.032.