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Son S, Joo B, Park M, Suh SH, Oh HS, Kim JW, Lee S, Ahn SJ, Lee JM. Development of RLK-Unet: a clinically favorable deep learning algorithm for brain metastasis detection and treatment response assessment. Front Oncol 2024; 13:1273013. [PMID: 38288101 PMCID: PMC10823345 DOI: 10.3389/fonc.2023.1273013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose/objectives Previous deep learning (DL) algorithms for brain metastasis (BM) detection and segmentation have not been commonly used in clinics because they produce false-positive findings, require multiple sequences, and do not reflect physiological properties such as necrosis. The aim of this study was to develop a more clinically favorable DL algorithm (RLK-Unet) using a single sequence reflecting necrosis and apply it to automated treatment response assessment. Methods and materials A total of 128 patients with 1339 BMs, who underwent BM magnetic resonance imaging using the contrast-enhanced 3D T1 weighted (T1WI) turbo spin-echo black blood sequence, were included in the development of the DL algorithm. Fifty-eight patients with 629 BMs were assessed for treatment response. The detection sensitivity, precision, Dice similarity coefficient (DSC), and agreement of treatment response assessments between neuroradiologists and RLK-Unet were assessed. Results RLK-Unet demonstrated a sensitivity of 86.9% and a precision of 79.6% for BMs and had a DSC of 0.663. Segmentation performance was better in the subgroup with larger BMs (DSC, 0.843). The agreement in the response assessment for BMs between the radiologists and RLK-Unet was excellent (intraclass correlation, 0.84). Conclusion RLK-Unet yielded accurate detection and segmentation of BM and could assist clinicians in treatment response assessment.
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Affiliation(s)
- Seungyeon Son
- Department of Artificial Intelligence, Hanyang University, Seoul, Republic of Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Hee Sang Oh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Seoyoung Lee
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
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Dutriaux C, Robert C, Grob JJ, Mortier L, Dereure O, Lebbe C, Mansard S, Grange F, Neidhardt EM, Lesimple T, Machet L, Bedane C, Maillard H, Dalac-Rat S, Nardin C, Szenik A, Denden A, Saiag P. An open label, non-randomised, phase IIIb study of trametinib in combination with dabrafenib in patients with unresectable (stage III) or distant metastatic (stage IV) BRAF V600-mutant melanoma: A subgroup analysis of patients with brain metastases. Eur J Cancer 2022; 175:254-262. [PMID: 36170791 DOI: 10.1016/j.ejca.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite the poor prognosis associated with melanoma brain metastases (BM), data concerning these patients and their inclusion in clinical trials remains scarce. We report here the efficacy results of a subgroup analysis in patients with BRAFV600-mutant melanoma and BM treated with BRAF and MEK inhibitors dabrafenib (D) and trametinib (T). PATIENTS AND METHODS This phase IIIb single-arm, open-label, multicenter, French study included patients with unresectable stage IIIc or IV BRAFV600-mutant melanoma with or without BM. The present analysis focuses on patients with BM. Response rates were determined clinically and/or radiologically as per standard clinical practice. Progression-free survival (PFS) was estimated using the Kaplan Meier analysis and modelled with multivariate Cox regression model. Risk subgroups were identified using an exponential regression tree analysis. Significance was set at p < 0.05. RESULTS Between March 2015 and November 2016, 856 patients were included and 275 (32%) patients had BM. Median PFS was 5.68 months (95% confidence interval [CI], 5.29-6.87). Significant independent factors associated with shorter PFS were ECOG ≥1, elevated serum lactate dehydrogenase (LDH), ≥3 metastatic sites, and non-naïve status. The binary-split classification and regression tree modelling identified baseline LDH and ECOG status as major prognostic factors. CONCLUSION This is to date the largest, close to real-world, study in advanced BRAFV600-mutant melanoma patients with BM treated with D+T. ECOG >1, ≥3 metastatic sites and elevated LDH were associated with shorter PFS, a finding previously demonstrated only in patients without BM. Further studies are warranted to determine the optimal treatment sequence in this population.
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Affiliation(s)
- Caroline Dutriaux
- Department of Dermatology, CHU Bordeaux Hôpital St. André, Bordeaux, France.
| | - Caroline Robert
- Department of Dermatology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Jacques Grob
- Department of Dermatology, Aix Marseille University, and APHM University Hospital Timone, Marseille, France
| | - Laurent Mortier
- Department of Dermatology, Hopital Claude Huriez, Lille, France
| | - Olivier Dereure
- Department of Dermatology, CHU Montpellier, Montpellier, France
| | - Céleste Lebbe
- Université de Paris, INSERM U976, Team 1, HIPI, F-75010, Paris, France; AP-HP Hôpital Saint Louis, Service de Dermatologie, F-75010, Paris, France
| | - Sandrine Mansard
- Department of Dermatology, CHU Estaing, Clermont-Ferrand, France
| | | | | | - Thierry Lesimple
- Department of Medical Oncology, Eugene Marquis Center, Rennes, France
| | - Laurent Machet
- Department of Dermatology, CHRU de Tours et Université François Rabelais de Tours, Tours, France
| | | | | | | | - Charlée Nardin
- Dermatology, CHU de Besançon, INSERM U-1098, University of Besançon, Besançon, France
| | - Alexandra Szenik
- Department of Medical Oncology, Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - Amine Denden
- Department of Medical Oncology, Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - Philippe Saiag
- Department of Dermatology, AP-HP, & EA 4340, University UVSQ, University Paris-Saclay, Boulogne-Billancourt, France
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Zhou Z, Ma A, Feng Q, Wang R, Cheng L, Chen X, Yang X, Liao K, Miao Y, Qiu Y. Super‐resolution of brain tumor MRI images based on deep learning. J Appl Clin Med Phys 2022; 23:e13758. [DOI: 10.1002/acm2.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/07/2022] [Accepted: 08/02/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Zhiyi Zhou
- Brain Injury Center, Department of Neurosurgery Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Anbang Ma
- Shanghai Xunshi Technology Co., Ltd. Shanghai China
| | - Qiuting Feng
- School of Electronic Information and Electrical Engineering Shanghai Jiao Tong University Shanghai China
| | - Ran Wang
- Department of Neurosurgery Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Lilin Cheng
- Department of Neurosurgery Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xin Chen
- Department of Neurosurgery Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xi Yang
- Brain Injury Center, Department of Neurosurgery Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Keman Liao
- Brain Injury Center, Department of Neurosurgery Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Yifeng Miao
- Department of Neurosurgery Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Yongming Qiu
- Brain Injury Center, Department of Neurosurgery Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
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van Grinsven EE, Nagtegaal SHJ, Verhoeff JJC, van Zandvoort MJE. The Impact of Stereotactic or Whole Brain Radiotherapy on Neurocognitive Functioning in Adult Patients with Brain Metastases: A Systematic Review and Meta-Analysis. Oncol Res Treat 2021; 44:622-636. [PMID: 34482312 DOI: 10.1159/000518848] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022]
Abstract
Background & Objectives: Radiotherapy is standard treatment for patients with brain metastases (BMs), although it may lead to radiation-induced cognitive impairment. This review explores the impact of whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) on cognition. METHODS The PRISMA guidelines were used to identify articles on PubMed and EmBase reporting on objective assessment of cognition before, and at least once after radiotherapy, in adult patients with nonresected BMs. RESULTS Of the 867 records screened, twenty articles (14 unique studies) were included. WBRT lead to decline in cognitive performance, which stabilized or returned to baseline in patients with survival of at least 9-15 months. For SRS, a decline in cognitive performance was sometimes observed shortly after treatment, but the majority of patients returned to or remained at baseline until a year after treatment. CONCLUSIONS These findings suggest that after WBRT, patients can experience deterioration over a longer period of time. The cognitive side effects of SRS are transient. Therefore, this review advices to choose SRS as this will result in lowest risks for cognitive adverse side effects, irrespective of predicted survival. In an already cognitively vulnerable patient population with limited survival, this information can be used in communicating risks and aid in making educated decisions.
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Affiliation(s)
- Eva Elisabeth van Grinsven
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Steven H J Nagtegaal
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.,Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Colditz M, Lee S, Eastgate M, Elder S, Brandis P, Anderson D, Withers T, Jeffree R, Pinkham M, Olson S. Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Xue J, Wang B, Ming Y, Liu X, Jiang Z, Wang C, Liu X, Chen L, Qu J, Xu S, Tang X, Mao Y, Liu Y, Li D. Deep learning-based detection and segmentation-assisted management of brain metastases. Neuro Oncol 2021; 22:505-514. [PMID: 31867599 DOI: 10.1093/neuonc/noz234] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional T1 magnetization prepared rapid acquisition gradient echo (3D-T1-MPRAGE) is preferred in detecting brain metastases (BM) among MRI. We developed an automatic deep learning-based detection and segmentation method for BM (named BMDS net) on 3D-T1-MPRAGE images and evaluated its performance. METHODS The BMDS net is a cascaded 3D fully convolution network (FCN) to automatically detect and segment BM. In total, 1652 patients with 3D-T1-MPRAGE images from 3 hospitals (n = 1201, 231, and 220, respectively) were retrospectively included. Manual segmentations were obtained by a neuroradiologist and a radiation oncologist in a consensus reading in 3D-T1-MPRAGE images. Sensitivity, specificity, and dice ratio of the segmentation were evaluated. Specificity and sensitivity measure the fractions of relevant segmented voxels. Dice ratio was used to quantitatively measure the overlap between automatic and manual segmentation results. Paired samples t-tests and analysis of variance were employed for statistical analysis. RESULTS The BMDS net can detect all BM, providing a detection result with an accuracy of 100%. Automatic segmentations correlated strongly with manual segmentations through 4-fold cross-validation of the dataset with 1201 patients: the sensitivity was 0.96 ± 0.03 (range, 0.84-0.99), the specificity was 0.99 ± 0.0002 (range, 0.99-1.00), and the dice ratio was 0.85 ± 0.08 (range, 0.62-0.95) for total tumor volume. Similar performances on the other 2 datasets also demonstrate the robustness of BMDS net in correctly detecting and segmenting BM in various settings. CONCLUSIONS The BMDS net yields accurate detection and segmentation of BM automatically and could assist stereotactic radiotherapy management for diagnosis, therapy planning, and follow-up.
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Affiliation(s)
- Jie Xue
- School of Business, Shandong Normal University, Jinan, China
| | - Bao Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yang Ming
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuejun Liu
- School of Business, Shandong Normal University, Jinan, China
| | - Zekun Jiang
- Shandong Key Laboratory of Medical Physics and Image Processing, School of Physics and Electronics, Shandong Normal University, Jinan, China
| | - Chengwei Wang
- Department of Neurosurgery, the Second Hospital of Shandong University, Jinan, China
| | - Xiyu Liu
- Department of Radiology, the Affiliated Hospital of Qingdao University Medical College, Qingdao, China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianhua Qu
- School of Business, Shandong Normal University, Jinan, China
| | - Shangchen Xu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xuqun Tang
- Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yingchao Liu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing, School of Physics and Electronics, Shandong Normal University, Jinan, China
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7
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Evidence of dose-response following hypofractionated stereotactic radiotherapy to the cavity after surgery for brain metastases. J Neurooncol 2020; 146:357-362. [PMID: 31907796 DOI: 10.1007/s11060-019-03383-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVE A retrospective review of consecutive patients between January 2012 and December 2018 receiving hypofractionated stereotactic radiotherapy (HSRT) to the cavity after resection for brain metastases was performed. METHODS Treatment was delivered using an appropriately commissioned linear accelerator. The primary outcome was time to radiological or histological confirmation of local recurrence following completion of HSRT. Dose-fractionation regimens were converted to biologically 2 Gy-equivalent doses assuming α/β = 10 (EQD2[10]). Multivariate Cox proportional hazards modelling was performed to determine hazard ratios (HR) with respective 95% confidence intervals (CI). The Log-rank test was used to determine p values taking statistical significance p < 0.05. RESULTS There were 134 patients and 144 cavities identified. The most common primary histologies were melanoma (n = 49) and lung (n = 32). 116 patients (87%) underwent a gross total resection. Median planning target volume (PTV) was 28 cm3 (range 2.4-149.2). Median EQD2[10] was 38.4 Gy (range 22.3-59.7) and 24 Gy in 3 fractions was the most common regimen. 12 (9%) patients demonstrated local recurrence at median interval 215 days (range 4-594). 7 (5%) patients experienced grade 3 or higher toxicities. In multivariate analysis, EQD2[10] was associated with local failure such that increased equivalent doses improved local control [HR = 0.79 and 95% CI 0.65-0.96, p = 0.0192]. There were no significant associations for primary histology, patient age, volume of residual disease, PTV volume or location. CONCLUSION This large series demonstrates that HSFRT to the surgical resection cavity for brain metastases has improved local control with increasing dose. Rates of grade 3 or higher toxicity were low overall.
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8
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Abstract
Due to the aggressive nature of hepatocellular carcinoma (HCC), most patients succumb to disease before any distant metastasis, such as to the central nervous system (CNS), can occur. Thus only a handful of cases of metastasis to the skull base have been described. After a thorough review of the available literature published since 1950, we report the sixth case of HCC metastasis to the clivus. In this case, a 65-year-old man with a history of melanoma presented with sudden onset of right-sided headache and complete ophthalmoplegia of the right eye for one month. MRI of the brain with and without contrast demonstrated a homogeneously enhancing lesion involving the clivus with evidence of invasion into the right cavernous sinus. Through further body imaging, he was found to have an infiltrative lesion in the left hepatic lobe and underwent an ultrasound-guided biopsy of said lesion that was proven to be well-differentiated hepatocellular carcinoma. An endonasal endoscopic biopsy of his clival lesion was performed and the final pathology was consistent with a metastatic HCC. This case demonstrates the impact of obtaining a surgical specimen of clival tumors to confirm the suspected diagnosis, as well as to perform molecular studies that can drive post-operative decision-making and prognosis. As in this case, the final diagnosis altered treatment plans from that of melanoma, with systemic chemotherapy and radiosurgery, to stereotactic radiosurgery and intrahepatic radioembolization.
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Affiliation(s)
| | - Yasir R Khan
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Danny Blais
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Bandana Mahato
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
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Bi N, Ma Y, Xiao J, Zhang H, Xu Y, Tian Y, Li J, Zhang Y, Liu Q, Wang K, Deng L, Wang W, Chen X, Liu F, Zhao R, Yang S, Huang X, Yi J, Hu C, Li Y. A Phase II Trial of Concurrent Temozolomide and Hypofractionated Stereotactic Radiotherapy for Complex Brain Metastases. Oncologist 2019; 24:e914-e920. [PMID: 30996008 DOI: 10.1634/theoncologist.2018-0702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/11/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Complex brain metastases (BMs), such as large lesions, lesions within or close to eloquent locations, or multiple recurrent/progressive BMs, remain the most challenging forms of brain cancer because of decreased intracranial control rates and poor survival. In the present study, we report the results from a single institutional phase II trial of concurrent temozolomide (TMZ) with hypofractionated stereotactic radiotherapy (HFSRT) in patients with complex brain metastases, including assessment of its feasibility and toxicity. PATIENTS AND METHODS Fifty-four patients with histologically proven primary cancer and complex BMs were enrolled between 2010 and 2015. All the patients were treated with concurrent HFSRT and TMZ (administrated orally at a dosage of 75 mg/m2 per day for at least 20 days). The primary endpoint was overall survival (OS). RESULTS The median follow-up time was 30.6 months. The local control rates at 1 and 2 years were 96% and 82%, respectively. The median OS was 17.4 months (95% confidence interval [CI], 12.6-22.2), and the OS rates at 1 and 2 years were 65% (95% CI, 52%-78%) and 33% (19%-47%). Only six patients (15.8%) died of intracranial disease. The median brain metastasis-specific survival was 46.9 months (95% CI, 35.5-58.4). Treatment-related grade 3-4 adverse events were rare and included one grade 3 hematological toxicity and two grade 3 liver dysfunctions. CONCLUSION Treatment using HFSRT concurrent with TMZ was well tolerated and could significantly extend OS compared with historical controls in complex BMs. Large randomized clinical trials are warranted. Trial registration ID: NCT02654106. IMPLICATIONS FOR PRACTICE The treatment using hypofractionated stereotactic radiotherapy concurrent with temozolomide appeared to be safe and could significantly extend overall survival compared with historical control in complex brain metastases. Large randomized clinical trials are warranted to verify our results.
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Affiliation(s)
- Nan Bi
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuchao Ma
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jianping Xiao
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hongmei Zhang
- Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yingjie Xu
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuan Tian
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junling Li
- Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye Zhang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qingfeng Liu
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kai Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Lei Deng
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wenqing Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuesong Chen
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Feng Liu
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ruizhi Zhao
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Siran Yang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaodong Huang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junlin Yi
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yexiong Li
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Nicholls LW, Pinkham MB, Bernard A, Lusk R, Watkins T, Hall B, Olson S, Foote MC. Radiological Kinetics of Brain Metastases and Clinical Implications for Patients Treated With Stereotactic Radiosurgery. Clin Oncol (R Coll Radiol) 2018; 31:34-40. [PMID: 30279038 DOI: 10.1016/j.clon.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/03/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
AIMS Select patients with brain metastases receive stereotactic radiosurgery (SRS) with the objective of improving survival and intracranial disease control. Brain metastases number and volume are prognostic factors used to inform patient selection. The aim of this study was to assess the rate of change of brain metastases size and number (growth kinetics) between the diagnostic and day of SRS magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS All patients treated with Gamma Knife SRS between October 2015 and April 2017 were included in this single-centre retrospective analysis. Brain metastases number and diameter were recorded at diagnosis and treatment. For patients with multiple brain metastases, the largest lesion was the index lesion. Distant intracranial control and overall survival were reported from the date of SRS. RESULTS In total, 146 patients received 156 episodes of SRS. The median interval between diagnostic and SRS MRI was 20 days (range 1-68). Interval growth in the index lesion of at least 3 mm or the development of a new brain metastasis was noted in 60.2% of patients. This was associated with age less than 60 years (P = 0.001), Eastern Cooperative Oncology Group (ECOG) performance status 2 or above (P = 0.04), non-small cell lung carcinoma (NSCLC) (P = 0.03) or melanoma histologies (P = 0.05) and uncontrolled extracranial disease (P = 0.05). These patients were also more likely to develop distant intracranial recurrence (P = 0.046). Clinically significant growth was not associated with scan interval or differences in overall survival. The Kaplan-Meier estimate of probability of survival at 12 months was 59.3% (95% confidence interval 46.7-75.2%) for all patients. CONCLUSION Intracranial progression between diagnosis and day of SRS is common. Risk factors are uncontrolled extracranial disease, poorer performance status, NSCLC or melanoma histologies and age less than 60 years. These patients would benefit from an MRI closer to treatment to inform patient selection and target delineation for SRS planning.
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Affiliation(s)
- L W Nicholls
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
| | - M B Pinkham
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - A Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - R Lusk
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - T Watkins
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - B Hall
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - S Olson
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - M C Foote
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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11
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Wang B, Zhang Y, Zhao B, Zhao P, Ge M, Gao M, Ding F, Xu S, Liu Y. Postcontrast T1 Mapping for Differential Diagnosis of Recurrence and Radionecrosis after Gamma Knife Radiosurgery for Brain Metastasis. AJNR Am J Neuroradiol 2018; 39:1025-1031. [PMID: 29724761 DOI: 10.3174/ajnr.a5643] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/03/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The differential diagnosis of radionecrosis and tumor recurrence in brain metastases is challenging. We investigated the diagnostic efficiency of postcontrast T1 mapping in solving this problem. MATERIALS AND METHODS Between March 2016 and June 2017, fifty-six patients with brain metastases who underwent contrast-enhanced cerebral T1 mapping were recruited for this prospective study. The findings revealed new enhancement after gamma knife radiosurgery. The subjects were assigned to radionecrosis and recurrence groups based on follow-up (median, 11.5 months) and histopathologic results. T1 values of lesions 5 (T15min) and 60 (T160min) minutes after administration of contrast agent and their difference (T1differ) were compared between the 2 groups with the 2-tailed Mann-Whitney U test. Receiver operating characteristic curves were used to determine the optimum cutoff values for differential diagnosis. RESULTS There were significant differences between the 2 groups in T15min, T160min, and T1differ values (P = .012, P = .004, and P < .001, respectively). Relative to T15min and T160min, T1differ exhibited greater sensitivity and specificity (P < .001, respectively) in identifying radionecrosis. The optimum T1differ value for differential diagnosis was 71.1 ms (area under the curve = 0.97; 95% CI, 0.93-1.00), with sensitivity and specificity of 81.5% and 96.5%, respectively. CONCLUSIONS Postcontrast T1 mapping is optimal for the differential diagnosis of radionecrosis and tumor recurrence. Among T1 parameters, T1differ is the most powerful parameter for differential diagnosis. Advantages in terms of quantitative analysis and high resolution portend the wide use of postcontrast T1 mapping in the future.
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Affiliation(s)
- B Wang
- From the School of Medicine (B.W.)
| | - Y Zhang
- Shandong Medical Imaging Research Institute (Y.Z., B.Z.), Shandong University, Jinan, P.R. China
| | - B Zhao
- Shandong Medical Imaging Research Institute (Y.Z., B.Z.), Shandong University, Jinan, P.R. China
| | - P Zhao
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - M Ge
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - M Gao
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - F Ding
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - S Xu
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China.
| | - Y Liu
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China.
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An evaluation of the BrainLAB 6D ExacTrac/Novalis Tx System for image-guided intracranial radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposeStereotactic-fractionated radiotherapy and radiosurgery (RS) for benign and malignant intracranial lesions relies on a very high degree of accuracy in dose alignment due to the ablative dose delivered, and therefore requires a high-precision image guidance modality. The aim of this review is to investigate the localisation and verification accuracy performance of ExacTrac (ET) and Novalis Tx System.Materials and methodsA systematic review of the database Science Direct was carried out using search terms ‘stereotactic radiotherapy (SRT)’ and ‘ET’. All articles before 2000 were excluded. Only articles that involved intracranial lesions, with the exception of one article, were included in the final review.ResultsResults from gold standard Hidden Target Tests and patient data show that patient position can be reproduced within 1·0 mm with the use of ET imaging. In addition, the 6 degrees of freedom algorithm function of ET allows for better translational accuracy as well optimal positioning when rotations are corrected for. Studies showed excellent correlation (p<0·01) between bony ET images and cone beam computed tomography (CBCT) soft tissue registration, evidencing the safe reliance of bony anatomy for image guidance via ET. Shifts were found to be comparable between CBCT and ET.ConclusionThere is the need for regular calibration to prevent systematic errors and potential geographic miss. However, due to ET’s additional benefits, including reduced concomitant dose and faster imaging time, ET is the superior image guidance modality for RS/SRT in the treatment of intracranial lesions.
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Hessen ED, van Buuren LD, Nijkamp JA, de Vries KC, Kong Mok W, Dewit L, van Mourik AM, Berlin A, van der Heide UA, Borst GR. Significant tumor shift in patients treated with stereotactic radiosurgery for brain metastasis. Clin Transl Radiat Oncol 2017; 2:23-28. [PMID: 29657996 PMCID: PMC5893526 DOI: 10.1016/j.ctro.2016.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Linac-based stereotactic radiosurgery (SRS) for brain metastases may be influenced by the time interval between treatment preparation and delivery, related to risk of anatomical changes. We studied tumor position shifts and its relations to peritumoral volume edema changes over time, as seen on MRI. Methods Twenty-six patients who underwent SRS for brain metastases in our institution were included. We evaluated the occurrence of a tumor shift between the diagnostic MRI and radiotherapy planning MRI. For 42 brain metastases the tumor and peritumoral edema were delineated on the contrast enhanced T1weighted and FLAIR images of both the diagnostic MRI and planning MRI examinations. Centre of Mass (CoM) shifts and tumor borders were evaluated. We evaluated the influence of steroids on peritumoral edema and tumor volume and the correlation with CoM and tumor border changes. Results The median values of the CoM shifts and of the maximum distances between the tumor borders obtained from the diagnostic MRI and radiotherapy planning MRI were 1.3 mm (maximum shift of 5.0 mm) and 1.9 mm (maximum distance of 7.4 mm), respectively. We found significant correlations between the absolute change in edema volume and the tumor shift of the CoM (p < 0.001) and tumor border (p = 0.040). Patients who received steroids did not only had a decrease in peritumoral edema, but also had a median decrease in tumor volume of 0.02 cc while patients who did not receive steroids had a median increase of 0.06 cc in tumor volume (p = 0.035). Conclusion Our results show that large tumor shifts of brain metastases can occur over time. Because shifts may have a significant impact on the local dose coverage, we recommend minimizing the time between treatment preparation and delivery for Linac based SRS.
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Affiliation(s)
- Eline D Hessen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laurens D van Buuren
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper A Nijkamp
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kim C de Vries
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wai Kong Mok
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Dewit
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anke M van Mourik
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerben R Borst
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Characterisation of Lesions after Stereotactic Radiosurgery for Brain Metastases: Impact of Delayed Contrast Magnetic Resonance Imaging. Clin Oncol (R Coll Radiol) 2016; 29:143-150. [PMID: 27777145 DOI: 10.1016/j.clon.2016.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 11/22/2022]
Abstract
AIMS To investigate if brain metastases and radiation injuries after stereotactic radiosurgery (SRS) have different signal intensity (SI) time courses up to 55 min after contrast agent application and if delayed contrast magnetic resonance imaging (MRI) contributes to improve diagnostic accuracy. MATERIALS AND METHODS Thirty-four consecutive patients treated with SRS for cerebral metastases were prospectively enrolled in the study. T1-weighted images were acquired on a 3-Tesla MR unit at three time points, at 2 (TP1), 15 (TP2) and 55 (TP3) min after administering contrast agent. A simultaneous, matched-pairs approach was used for region of interest analysis of the entire contrast-enhancing lesion (SI-e), the centre (SI-c), the border of the lesion (SI-b) and the adjacent non-contrast-enhancing tissue (SI-p). SIs of brain metastases and radiation injuries after SRS were compared using a two-level, linear, mixed-effects regression model. RESULTS In total, 41 lesions were analysed: 16 metastases and 25 radiation injuries. The SI time course of SI-e, SI-c and SI-b proved to be significantly different for both entities (P < 0.001) from TP2 to TP3. The SI of 39/41 lesions increased from TP1 to TP2 for the three parameters. Radiation injuries showed a further signal increase at least for SI-c from TP2 to TP3, whereas for all the three parameters SI decreased in all metastases. CONCLUSION Brain metastases and radiation injuries after SRS have a characteristic and statistically significantly different SI time course on sequential gadolinium enhancement MRI when late MR studies are included.
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Neuro-oncology Virtual Special Issue. Clin Oncol (R Coll Radiol) 2016; 28:540-1. [PMID: 27188782 DOI: 10.1016/j.clon.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
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Pinkham MB, Sanghera P, Wall GK, Dawson BD, Whitfield GA. Neurocognitive Effects Following Cranial Irradiation for Brain Metastases. Clin Oncol (R Coll Radiol) 2015; 27:630-9. [PMID: 26119727 DOI: 10.1016/j.clon.2015.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/03/2015] [Indexed: 12/17/2022]
Abstract
About 90% of patients with brain metastases have impaired neurocognitive function at diagnosis and up to two-thirds will show further declines within 2-6 months of whole brain radiotherapy. Distinguishing treatment effects from progressive disease can be challenging because the prognosis remains poor in many patients. Omitting whole brain radiotherapy after local therapy in good prognosis patients improves verbal memory at 4 months, but the effect of higher intracranial recurrence and salvage therapy rates on neurocognitive function beyond this time point is unknown. Hippocampal-sparing whole brain radiotherapy and postoperative stereotactic radiosurgery are investigational techniques intended to reduce toxicity. Here we describe the changes that can occur and review technological, pharmacological and practical approaches used to mitigate their effect in clinical practice.
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Affiliation(s)
- M B Pinkham
- Clinical Oncology, The University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK; School of Medicine, University of Queensland, Brisbane, Australia.
| | - P Sanghera
- Hall Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - G K Wall
- Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | - B D Dawson
- Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | - G A Whitfield
- Clinical Oncology, The University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
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Clinical Oncology: Past, Present and Future. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2015.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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