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• W3094089035 abstract "To identify lesions that are likely to require adaptive radiotherapy planning, we evaluated changes in the tumor size on magnetic resonance imaging (MRI) during stereotactic radiotherapy (SRT) for large metastatic brain tumors. Between November 2011 and December 2019, 110 patients with 121 metastatic brain tumors were treated by 10-fraction SRT using a linear accelerator at our institution. Median prescribed dose was 40.0 Gy (range, 35.0–40.0). The median treatment period was 13 days (range, 10–14). The doses were prescribed to isocenter for 74 lesions, D50 (dose covering 50% of planning target volume) for 6 lesions, and D95 for 41 lesions. Gadolinium-enhanced MRI were performed twice to assess the size and shape of the lesions; baseline MRI was performed within 7 days before SRT start, and post-SRT MRI was performed from 2 days before to 1 day after the last day of SRT. The estimated diameter of the tumor as a sphere was determined using the square root of the largest cross-sectional axis and its orthogonal axis. This study included tumors with a major axis greater than 20 mm. Excluded were patients who had a history of radiation therapy or tumorectomy for the same lesion and those with tumors that became irregular with aggregated multiple lesions. Corticosteroids were administered before and during SRT in 119 lesions (98%). The median major axis of the tumors before SRT was 32 mm (20–58), and 88 lesions showed edema around the tumor. The mean (standard deviation) of the estimated diameter was significantly reduced from 30.6 (6.8) to 28.6 (7.1) mm (P <0.01). The estimated diameter was significantly reduced in 88 lesions with edema on pre-SRT MRI (P <0.01), and tended to decrease and increase in lesions with improved and worsened edema compared to post-SRT MRI, respectively. In 57 lesions with no change in edema during SRT, there was no significant difference in changes of the estimated diameters between 30 lesions without edema and 27 lesions with edema on pre-SRT MRI. Cystic lesions seemed to exhibit a wide range of variation, but there was no significant difference. Also, no significant difference was observed in lesions with intratumoral hemorrhage. With respect to the pathology of the primary tumor, small cell carcinoma metastases showed a large reduction in size. Lesions prescribed to D95 shrank significantly, although the difference was not significant in multivariate analysis, while edema on pre-SRT MRI and small cell carcinoma remained as significant factors. The timing of corticosteroids introduction did not seem to influence the shrinkage rate. During fractionated SRT, the treatment plan should be revised taking the presence and fluctuation of edema around the brain tumor into account." @default.
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• W3094089035 date "2020-11-01" @default.
• W3094089035 modified "2023-09-27" @default.
• W3094089035 title "Changes In The Size Of Large Metastatic Brain Tumors During Fractionated Stereotactic Radiotherapy" @default.
• W3094089035 doi "https://doi.org/10.1016/j.ijrobp.2020.07.088" @default.
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