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Takata S, Kosen K, Matsumoto A, Tanabe M, Itaya T, Asayama Y. Growth speed of large brain metastases between diagnostic and radiosurgical planning MRI and predictors of rapid tumor growth. Jpn J Radiol 2024; 42:546-552. [PMID: 38212514 PMCID: PMC11056330 DOI: 10.1007/s11604-023-01524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE We aimed to assess volumetric changes of large brain metastases (≥ 2 cm) between their diagnosis and planning for treatment with fractionated stereotactic radiation surgery (fSRS). Predictors of rapid tumor growth were also analyzed. MATERIALS AND METHODS One hundred nine patients harboring 126 large brain metastases were retrospectively evaluated. Tumor characteristics were evaluated on diagnostic magnetic resonance imaging (dMRI) and MRI performed when planning fSRS (pMRI). Average tumor growth rate and percentage growth rate were calculated. Predictors of rapid growth (percentage growth rate > 5%) were determined using multivariate logistic regression. RESULTS Both tumor diameter and volume were significantly larger on pMRI than on dMRI (P < 0.001). Median tumor percentage growth rate was 2.6% (range, - 10.8-43.3%). Eighty-eight tumors (70%) were slow-growing (percentage growth rate < 5%) and 38 (30%) grew rapidly (percentage growth rate ≥ 5%). Major peritumoral edema and no steroids were predictors of rapid tumor growth. CONCLUSION Large brain metastases can grow considerably between the time of diagnosis and the time of fSRS treatment planning. We recommend the time between dMRI and fSRS treatment initiation be as short as possible.
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Affiliation(s)
- Shoko Takata
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
- Department of Radiology, Oita Prefectural Hospital, 2-8-1, Bunyo, Oita, 870-8511, Japan.
| | - Kazuhisa Kosen
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
- Keiwakai Oka Hospital, 3-7-11 Nishitsurusaki, Oita, 870-0105, Japan
| | - Akira Matsumoto
- Department of Radiation Therapy, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan
| | - Motoko Tanabe
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takayoshi Itaya
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yoshiki Asayama
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Miura H, Kenjo M, Doi Y, Ueda T, Nakao M, Ozawa S, Nagata Y. Effect of Target Changes on Target Coverage and Dose to the Normal Brain in Fractionated Stereotactic Radiation Therapy for Metastatic Brain Tumors. Adv Radiat Oncol 2023; 8:101264. [PMID: 37457819 PMCID: PMC10344692 DOI: 10.1016/j.adro.2023.101264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/27/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose We evaluated the dosimetric effect of tumor changes in patients with fractionated brain stereotactic radiation therapy (SRT) on the tumor and normal brain using repeat verification magnetic resonance imaging (MRI) in the middle of the treatment period. Methods and Materials Fifteen large intracranial metastatic lesions with fractionated SRT were scanned employing standardized planning MRI (MRI-1). Repeat verification MRI (MRI-2) were performed during the middle of the irradiation period. Gross tumor volume (GTV) was defined as the volume of the contrast-enhancing lesion on T1-weighted MRI with gadolinium contrast agent. The doses to the tumor and normal brain were evaluated on the MRI-1 scan. Beam configuration and intensity on the initial volumetric modulated arc therapy plan were used to evaluate the dose to the tumor and the normal brain on MRI-2. We evaluated the effect of D98% (percent dose irradiating 98% of the volume) on the GTV using the plans on the MRI-1 and MRI-2 scans. For the normal brain, the V90%, V80%, and V50% (volume of the normal brain receiving >90%, 80%, and 50% of the prescribed dose, respectively) were investigated. Results Three (20% of the total) and 4 (26% of the total) tumors exhibited volume shrinkage or enlargement changes of >10%. Five (33% of the total) tumors exhibited volume shrinkage and enlargement changes of <10%. Three tumors (20% of the total) showed no volume changes. D98% of the GTV increased in patients with tumor shrinkage because of dose inhomogeneity and decreased in patients with tumor enlargement, with a coefficient of determination of 0.28. The V90%, V80%, and V50% increase with decreasing tumor volumes and were linearly related to the tumor volume difference with a coefficient of determination values of 0.97, 0.98, and 0.97, respectively. Conclusions Repeat verification MRI for brain fractionated SRT during the treatment period should be considered to reduce the magnitude of target underdosing or normal brain overdosing.
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Affiliation(s)
- Hideharu Miura
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Masahiro Kenjo
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yoshiko Doi
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Taro Ueda
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
| | - Minoru Nakao
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yasushi Nagata
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
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Ocaña-Tienda B, Pérez-Beteta J, Jiménez-Sánchez J, Molina-García D, Ortiz de Mendivil A, Asenjo B, Albillo D, Pérez-Romasanta LA, Valiente M, Zhu L, García-Gómez P, González-Del Portillo E, Llorente M, Carballo N, Arana E, Pérez-García VM. Growth exponents reflect evolutionary processes and treatment response in brain metastases. NPJ Syst Biol Appl 2023; 9:35. [PMID: 37479705 PMCID: PMC10361973 DOI: 10.1038/s41540-023-00298-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023] Open
Abstract
Tumor growth is the result of the interplay of complex biological processes in huge numbers of individual cells living in changing environments. Effective simple mathematical laws have been shown to describe tumor growth in vitro, or simple animal models with bounded-growth dynamics accurately. However, results for the growth of human cancers in patients are scarce. Our study mined a large dataset of 1133 brain metastases (BMs) with longitudinal imaging follow-up to find growth laws for untreated BMs and recurrent treated BMs. Untreated BMs showed high growth exponents, most likely related to the underlying evolutionary dynamics, with experimental tumors in mice resembling accurately the disease. Recurrent BMs growth exponents were smaller, most probably due to a reduction in tumor heterogeneity after treatment, which may limit the tumor evolutionary capabilities. In silico simulations using a stochastic discrete mesoscopic model with basic evolutionary dynamics led to results in line with the observed data.
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Affiliation(s)
| | | | | | | | | | - Beatriz Asenjo
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Manuel Valiente
- Brain Metastasis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Lucía Zhu
- Brain Metastasis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Pedro García-Gómez
- Brain Metastasis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
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Kutuk T, Tolakanahalli R, Williams A, Tom MC, Vadhan JD, Appel H, Hall MD, Wieczorek DJJ, Davis S, McDermott MW, Ahluwalia MS, Mehta MP, Gutierrez AN, Kotecha R. Impact of MRI timing on tumor volume and anatomic displacement for brain metastases undergoing stereotactic radiosurgery. Neurooncol Pract 2021; 8:674-683. [PMID: 34777836 DOI: 10.1093/nop/npab047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The objective of this study was to evaluate the impact of the time interval between planning imaging and stereotactic radiosurgery (SRS) delivery on tumor volumes and spatial anatomic displacements of brain metastases (BM). Methods Consecutive patients diagnosed with BM treated with SRS over a 3-year period were evaluated. Only patients who underwent an institutionally standardized diagnostic MRI (MRI-1) and a treatment planning MRI (MRI-2) were included. The impact of histology, inter-scan time interval, lesion location, tumor volume, and diameter were evaluated on final lesion diameter, volume, anatomic displacement, and ultimate need for change in management (ie, expanding margins, rescanning). Results 101 patients (531 lesions) with a median inter-scan time interval of 8 days (range: 1-42 days) met the inclusion criteria. The median percentage increase in BM diameter and volume were 9.5% (IQR: 2.25%-24.0%) and 20% (IQR: 0.7%-66.7%). Overall, 147 lesions (27.7%) in 57 patients (56.4%) required a change in management. There was a statistically significant relationship between initial tumor diameter (cm) and change in management (OR: 2.69, 95% CI: 1.93-3.75; P < .001). Each day between MRI-1 and MRI-2 was associated with a change in management with an OR of 1.05 (95% CI: 1.03-1.07; P < .001). Conclusions Changes in tumor diameter, volume, and spatial position occur as a function of time. Planning imaging for SRS is recommended to occur in close temporal proximity to treatment; for those with delays, a larger setup margin may need to be used to ensure tumor coverage and account for positional changes.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Ranjini Tolakanahalli
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Andre Williams
- Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Martin C Tom
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jason D Vadhan
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Haley Appel
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - D Jay J Wieczorek
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Stephen Davis
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael W McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Manmeet S Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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Bourbonne V, Jaouen V, Hognon C, Boussion N, Lucia F, Pradier O, Bert J, Visvikis D, Schick U. Dosimetric Validation of a GAN-Based Pseudo-CT Generation for MRI-Only Stereotactic Brain Radiotherapy. Cancers (Basel) 2021; 13:1082. [PMID: 33802499 PMCID: PMC7959466 DOI: 10.3390/cancers13051082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Stereotactic radiotherapy (SRT) has become widely accepted as a treatment of choice for patients with a small number of brain metastases that are of an acceptable size, allowing for better target dose conformity, resulting in high local control rates and better sparing of organs at risk. An MRI-only workflow could reduce the risk of misalignment between magnetic resonance imaging (MRI) brain studies and computed tomography (CT) scanning for SRT planning, while shortening delays in planning. Given the absence of a calibrated electronic density in MRI, we aimed to assess the equivalence of synthetic CTs generated by a generative adversarial network (GAN) for planning in the brain SRT setting. METHODS All patients with available MRIs and treated with intra-cranial SRT for brain metastases from 2014 to 2018 in our institution were included. After co-registration between the diagnostic MRI and the planning CT, a synthetic CT was generated using a 2D-GAN (2D U-Net). Using the initial treatment plan (Pinnacle v9.10, Philips Healthcare), dosimetric comparison was performed using main dose-volume histogram (DVH) endpoints in respect to ICRU 91 guidelines (Dmax, Dmean, D2%, D50%, D98%) as well as local and global gamma analysis with 1%/1 mm, 2%/1 mm and 2%/2 mm criteria and a 10% threshold to the maximum dose. t-test analysis was used for comparison between the two cohorts (initial and synthetic dose maps). RESULTS 184 patients were included, with 290 treated brain metastases. The mean number of treated lesions per patient was 1 (range 1-6) and the median planning target volume (PTV) was 6.44 cc (range 0.12-45.41). Local and global gamma passing rates (2%/2 mm) were 99.1 CI95% (98.1-99.4) and 99.7 CI95% (99.6-99.7) respectively (CI: confidence interval). DVHs were comparable, with no significant statistical differences regarding ICRU 91's endpoints. CONCLUSIONS Our study is the first to compare GAN-generated CT scans from diagnostic brain MRIs with initial CT scans for the planning of brain stereotactic radiotherapy. We found high similarity between the planning CT and the synthetic CT for both the organs at risk and the target volumes. Prospective validation is under investigation at our institution.
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Affiliation(s)
- Vincent Bourbonne
- Radiation Oncology Department, CHRU Brest, 2 Avenue Foch, 29200 Brest, France; (N.B.); (F.L.); (O.P.); (U.S.)
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - Vincent Jaouen
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
- Institut Mines-Télécom Atlantique, 29200 Brest, France
| | - Clément Hognon
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - Nicolas Boussion
- Radiation Oncology Department, CHRU Brest, 2 Avenue Foch, 29200 Brest, France; (N.B.); (F.L.); (O.P.); (U.S.)
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - François Lucia
- Radiation Oncology Department, CHRU Brest, 2 Avenue Foch, 29200 Brest, France; (N.B.); (F.L.); (O.P.); (U.S.)
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - Olivier Pradier
- Radiation Oncology Department, CHRU Brest, 2 Avenue Foch, 29200 Brest, France; (N.B.); (F.L.); (O.P.); (U.S.)
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - Julien Bert
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - Dimitris Visvikis
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
| | - Ulrike Schick
- Radiation Oncology Department, CHRU Brest, 2 Avenue Foch, 29200 Brest, France; (N.B.); (F.L.); (O.P.); (U.S.)
- Laboratoire de Traitement de l’Information Médicale, Unité Mixte de Recherche 1101, Institut National de la Santé et de la Recherche, Université de Bretagne Occidentale, 29200 Brest, France; (V.J.); (C.H.); (J.B.); (D.V.)
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