Brain metastasis growth on preradiosurgical magnetic resonance imaging
Brain metastasis growth on preradiosurgical magnetic resonance imaging
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DOI：
10.1016/j.prro.2018.06.004
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发表时间：
2018-11-01
影响因子：
3.3
通讯作者：
Braunstein, Steve E.
中科院分区：
文献类型：
--
作者：
Garcia, Michael A.;Anwar, Mekhail;Braunstein, Steve E.
目的：先前的分析显示，在SRS前>14天使用无框架立体定向放射手术（SRS）治疗并计划使用磁共振成像（MRI）的脑转移瘤的局部控制（LC）较差。为了评估更差的LC可能是由于不明间隔转移增长和放射外科边缘错过，我们量化的增长前SRS的preradiosurgical imaging.Methods和materials：我们回顾了2010年和2013年之间在我们的机构接受固定框架SRS治疗脑转移瘤的患者的数据，并提供了预处理诊断性脑MRI和SRS计划MRI扫描。在治疗前MRI扫描和治疗当天计划MRI扫描上勾画转移灶的轮廓，以进行体积比较。计算了增长率。使用治疗前MRI扫描的连续体积轮廓扩张来确定SRS当天包围整个转移所需的最小边缘。结果：在165例患者的411个脑转移瘤中，治疗前和治疗后MRI的时间与转移瘤生长相关（P <0.001），平均生长速率为0.02 ml/d（95%可信区间0.01-0.03），14 d时体积增加1.35倍。MRI扫描之间的时间与SRS当天靶向整个脑转移体积所需的边缘量相关（P < .001），治疗前MRI（P < .001）和黑色素瘤组织学（P < .001）的转移体积也是如此。LC是不相关的增长率之间的患者接受固定架SRS。结论：预处理MRI和SRS之间的时间与脑转移瘤的增长，但LC是不妥协时，患者接受固定架SRS与同一天的MRI计划。边缘可能需要与无框SRS治疗转移瘤，以占之间的规划MRI和SRS deliveration.Summary的增长：在这项研究中，我们量化脑转移瘤的增长，随着时间的推移，利用2个预处理的磁共振成像扫描在2个时间点之间的帧固定放射手术治疗的患者。我们发现转移生长与时间、初始转移大小、黑色素瘤组织学和同期化疗相关。进行连续的边缘扩张显示了与放射手术当天靶向整个转移所需的边缘量相关的因素。(C)2018年美国放射肿瘤学会。爱思唯尔公司出版All rights reserved.
Purpose: A previous analysis showed that brain metastases that are treated with frameless stereotactic radiation surgery (SRS) and planned with magnetic resonance imaging (MRI) >14 days before SRS had worse local control (LC). To evaluate if worse LC may be due to unaccounted interval metastasis growth and radiosurgical marginal miss, we quantified growth before SRS on preradiosurgical imaging.Methods and materials: We reviewed data from patients who were treated with fixed-frame SRS for brain metastases at our institution between 2010 and 2013 and had pretreatment diagnostic brain MRI and SRS-planning MRI scans available. Metastases were contoured on the pretreatment MRI scan and the day-of-treatment planning MRI scan for volumetric comparison. Growth rates were calculated. Serial volumetric contour expansions on the pretreatment MRI scans were used to determine the minimum margin necessary to encompass the entire metastasis on day of the SRS. LC was estimated by Kaplan-Meier method.Results: Among 411 brain metastases in 165 patients, the time between pretreatment and treatment MRI was associated with metastasis growth (P < .001) with a mean growth rate of 0.02 ml/day (95% confidence interval, 0.01-0.03) and a 1.35-fold volume increase at 14 days. Time between MRI scans was associated with the amount of margin that was needed to target the entire brain metastasis volume on the day of the SRS (P < .001), as were volume of metastasis on the pretreatment MRI (P < .001) and melanoma histology (P < .001). LC was not associated with growth rate among patients who underwent fixed-frame SRS.Conclusions: Time between pretreatment MRI and SRS is associated with brain metastasis growth, but LC is not compromised when patients receive fixed-frame SRS with same-day MRI planning. Margins may be needed for metastases that are treated with frameless SRS to account for growth between the planning MRI and SRS delivery.Summary: In this study, we quantify brain metastasis growth over time by taking advantage of the availability of 2 pretreatment magnetic resonance imaging scans taken at 2 time points among patients treated with frame-fixed radiation surgery. We found that metastasis growth is associated with time, initial metastasis size, melanoma histology, and concurrent chemotherapy. Performing serial margin expansions demonstrated factors that are associated with the amount of margin that is needed to target the entire metastasis on the day of radiation surgery. (C) 2018 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.