Conservation of pyramidal tract in radiosurgery for brain metastases of lung adenocarcinoma: Three-dimensional analysis of biologically effective dose

Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relatio...

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Published in:	Radiotherapy and oncology Vol. 179; p. 109451
Main Authors:	Tang, Ke, Zhang, Nan, Yuan, Xiaodong, Qian, Zenghui, Li, Yang, Feng, Xu
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier B.V 01.02.2023
Subjects:	Adenocarcinoma of Lung Biologically effective dose Brain metastases Brain Neoplasms - secondary Hematology, Oncology, and Palliative Medicine Humans Motor function Pyramidal tract Pyramidal Tracts Radiosurgery - methods Retrospective Studies Stereotactic radiosurgery Three-dimensional model Treatment Outcome BED Pyramidal tract PTCF PT MR CI Biologically effective dose VIFs BMs Brain metastases HR Three-dimensionalmodel IQR GKS Stereotactic radiosurgery CT 3D DTI Motor function magnetic resonance Gamma Knife surgery interquartile range three-dimensional model pyramidal tract conservation failure variance inflation factors motor function 3-dimensional computed tomography brain metastases stereotactic radiosurgery pyramidal tract hazard ratio biologically effective dose diffusion tensor imaging confidence interval
ISSN:	0167-8140, 1879-0887, 1879-0887
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Abstract	Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma). We formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 × 200 × 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping. There were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that DLesion_min BED and DLesion_90% BED significantly predicted lesion progression (P <.001). DPT_Max BED and VPT_ BED40 significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of DLesion_min BED + DLesion_90% BED and DPT_Max BED + VPT_ BED40. The conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality.
AbstractList	Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma). We formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 × 200 × 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping. There were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that DLesion_min BED and DLesion_90% BED significantly predicted lesion progression (P <.001). DPT_Max BED and VPT_ BED40 significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of DLesion_min BED + DLesion_90% BED and DPT_Max BED + VPT_ BED40. The conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality. Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma). We formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 × 200 × 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping. There were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that D BED and D BED significantly predicted lesion progression (P <.001). D BED and V significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of D BED + D BED and D BED + V . The conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality. Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma).BACKGROUNDGamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically effective dose (BED) calculation on a voxel-by-voxel basis may provide data to establish clinically safe values. We aimed to assess the relationship of parameters extracted from the BED-volume histogram with outcomes of PT after GKS-treating target (adjacent BM of lung adenocarcinoma).We formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 × 200 × 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping.METHODSWe formed BED-volume histograms for 672 BMs in a retrospective cohort, using 3-dimensional (3D) coordinate values of PT, target, and each iso-centre to calculate the 3D BED distribution in a 200 × 200 × 200 matrix. PT conservation failure (PTCF) was judged clinically and radiologically and classified as lesion progression and radionecrosis. Cox proportional hazards models were used to analyse 3D BED parameters. Internal validation of models was performed by bootstrapping.There were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that DLesion_min BED and DLesion_90% BED significantly predicted lesion progression (P <.001). DPT_Max BED and VPT_ BED40 significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of DLesion_min BED + DLesion_90% BED and DPT_Max BED + VPT_ BED40.RESULTSThere were 116 (17.3 %) subjects with PTCF in the cohort, of which 74 (11.0 %) and 42 (6.3 %) were caused by lesion progression and radionecrosis, respectively. Multivariate analysis showed that DLesion_min BED and DLesion_90% BED significantly predicted lesion progression (P <.001). DPT_Max BED and VPT_ BED40 significantly predicted radionecrosis (P <.001). The model predicting PTCF showed fair discrimination and calibration of DLesion_min BED + DLesion_90% BED and DPT_Max BED + VPT_ BED40.The conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality.CONCLUSIONSThe conservation of PT in GKS for BMs of lung adenocarcinoma depends on the combination of PT-tolerated BED and target effective control BED. Therefore, a BED-volume histogram with a 3D BED algorithm is proposed to assess plan quality. Graphical abstract
ArticleNumber	109451
Author	Tang, Ke Li, Yang Yuan, Xiaodong Feng, Xu Zhang, Nan Qian, Zenghui
Author_xml	– sequence: 1 givenname: Ke surname: Tang fullname: Tang, Ke email: tangkeaccount@163.com organization: Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, PR China – sequence: 2 givenname: Nan surname: Zhang fullname: Zhang, Nan organization: Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi (middle) Road, Shanghai, PR China – sequence: 3 givenname: Xiaodong surname: Yuan fullname: Yuan, Xiaodong organization: Department of Radiology, The Eighth Medical Center of Chinese PLA General Hospital, 17 Heishanhu Road, Beijing, PR China – sequence: 4 givenname: Zenghui surname: Qian fullname: Qian, Zenghui organization: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Fanyang Road, Fengtai District, Beijing, PR China – sequence: 5 givenname: Yang surname: Li fullname: Li, Yang organization: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Road, Beijing, PR China – sequence: 6 givenname: Xu surname: Feng fullname: Feng, Xu organization: Department of Basic Medicine, Xiamen Medical College, 1999 Guankouzhong Road, Xiamen, Fujian Province, PR China
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Keywords	BED Pyramidal tract PTCF PT MR CI Biologically effective dose VIFs BMs Brain metastases HR Three-dimensionalmodel IQR GKS Stereotactic radiosurgery CT 3D DTI Motor function magnetic resonance Gamma Knife surgery interquartile range three-dimensional model pyramidal tract conservation failure variance inflation factors motor function 3-dimensional computed tomography brain metastases stereotactic radiosurgery pyramidal tract hazard ratio biologically effective dose diffusion tensor imaging confidence interval
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Snippet	Gamma knife surgery (GKS) for brain metastases (BMs) adjacent to the pyramidal tract (PT) is still a challenge to conduct. PT visualization and biologically... Graphical abstract
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StartPage	109451
SubjectTerms	Adenocarcinoma of Lung Biologically effective dose Brain metastases Brain Neoplasms - secondary Hematology, Oncology, and Palliative Medicine Humans Motor function Pyramidal tract Pyramidal Tracts Radiosurgery - methods Retrospective Studies Stereotactic radiosurgery Three-dimensional model Treatment Outcome
Title	Conservation of pyramidal tract in radiosurgery for brain metastases of lung adenocarcinoma: Three-dimensional analysis of biologically effective dose
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