Dose Reduction to Motor Structures in Adjuvant Fractionated Stereotactic Radiotherapy of Brain Metastases: nTMS-Derived DTI-Based Motor Fiber Tracking in Treatment Planning.

Diehl, Christian D; Rosenkranz, Enrike; Schwendner, Maximilian; Mißlbeck, Martin; Sollmann, Nico; Ille, Sebastian; Meyer, Bernhard; Combs, Stephanie E; Krieg, Sandro M

doi:10.3390/cancers15010282

journal article

Document type:: Article; Journal Article
Author(s):: Diehl, Christian D; Rosenkranz, Enrike; Schwendner, Maximilian; Mißlbeck, Martin; Sollmann, Nico; Ille, Sebastian; Meyer, Bernhard; Combs, Stephanie E; Krieg, Sandro M
Title:: Dose Reduction to Motor Structures in Adjuvant Fractionated Stereotactic Radiotherapy of Brain Metastases: nTMS-Derived DTI-Based Motor Fiber Tracking in Treatment Planning.
Abstract:: Background: Resection of brain metastases (BM) close to motor structures is challenging for treatment. Navigated transcranial magnetic stimulation (nTMS) motor mapping, combined with diffusion tensor imaging (DTI)-based fiber tracking (DTI-FTmot.TMS), is a valuable tool in neurosurgery to preserve motor function. This study aimed to assess the practicability of DTI-FTmot.TMS for local adjuvant radiotherapy (RT) planning of BM. Methods: Presurgically generated DTI-FTmot.TMS-based corticospinal tract (CST) reconstructions (FTmot.TMS) of 24 patients with 25 BM resected during later surgery were incorporated into the RT planning system. Completed fractionated stereotactic intensity-modulated RT (IMRT) plans were retrospectively analyzed and adapted to preserve FTmot.TMS. Results: In regular plans, mean dose (Dmean) of complete FTmot.TMS was 5.2 ± 2.4 Gy. Regarding planning risk volume (PRV-FTTMS) portions outside of the planning target volume (PTV) within the 17.5 Gy (50%) isodose line, the DTI-FTmot.TMS Dmean was significantly reduced by 33.0% (range, 5.9−57.6%) from 23.4 ± 3.3 Gy to 15.9 ± 4.7 Gy (p < 0.001). There was no significant decline in the effective treatment dose, with PTV Dmean 35.6 ± 0.9 Gy vs. 36.0 ± 1.2 Gy (p = 0.063) after adaption. Conclusions: The DTI-FTmot.TMS-based CST reconstructions could be implemented in adjuvant IMRT planning of BM. A significant dose reduction regarding motor structures within critical dose levels seems possible.
Journal title abbreviation:: Cancers (Basel)
Year:: 2022
Journal volume:: 15
Journal issue:: 1
Fulltext / DOI:: doi:10.3390/cancers15010282
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/36612277
TUM Institution:: Klinik und Poliklinik für Neurochirurgie; Klinik und Poliklinik für RadioOnkologie und Strahlentherapie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Neurochirurgie (Prof. Meyer)2022

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für RadioOnkologie und Strahlentherapie (Prof. Combs)2022