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Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma
SIMPLE SUMMARY: Malignant brain tumours have a poor prognosis and routinely require brain surgery followed by radiation treatment of the extended tumour cavity. We compared magnetic resonance images (MRIs) of 28 patients at two points in time: immediately after surgery and close before the start of...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216722/ https://www.ncbi.nlm.nih.gov/pubmed/37345177 http://dx.doi.org/10.3390/cancers15102840 |
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author | Dejonckheere, Cas Stefaan Thelen, Anja Simon, Birgit Greschus, Susanne Köksal, Mümtaz Ali Schmeel, Leonard Christopher Wilhelm-Buchstab, Timo Leitzen, Christina |
author_facet | Dejonckheere, Cas Stefaan Thelen, Anja Simon, Birgit Greschus, Susanne Köksal, Mümtaz Ali Schmeel, Leonard Christopher Wilhelm-Buchstab, Timo Leitzen, Christina |
author_sort | Dejonckheere, Cas Stefaan |
collection | PubMed |
description | SIMPLE SUMMARY: Malignant brain tumours have a poor prognosis and routinely require brain surgery followed by radiation treatment of the extended tumour cavity. We compared magnetic resonance images (MRIs) of 28 patients at two points in time: immediately after surgery and close before the start of radiation. Even though both MRIs were roughly only 3 weeks apart, we noted substantial differences in the position and size of the tumour cavity, surrounding affected brain tissue, the position of the midline, and bleeding in the surgical area. The brain anatomy, as seen in the MRI, guides the planning of radiation. Older images thus do not reflect the actual anatomy anymore, which might lead to insufficient treatment of the tumour site or increased side effects due to irradiation of healthy tissues. Our data support the use of a second MRI for radiation treatment planning as close to its start as possible. ABSTRACT: High-grade glioma has a poor prognosis, and radiation therapy plays a crucial role in its management. Every step of treatment planning should thus be optimised to maximise survival chances and minimise radiation-induced toxicity. Here, we compare structures needed for target volume delineation between an immediate postoperative magnetic resonance imaging (MRI) and a radiation treatment planning MRI to establish the need for the latter. Twenty-eight patients were included, with a median interval between MRIs (range) of 19.5 (8–50) days. There was a mean change in resection cavity position (range) of 3.04 ± 3.90 (0–22.1) mm, with greater positional changes in skull-distant (>25 mm) resection cavity borders when compared to skull-near (≤25 mm) counterparts (p < 0.001). The mean differences in resection cavity and surrounding oedema and FLAIR hyperintensity volumes were −32.0 ± 29.6% and −38.0 ± 25.0%, respectively, whereas the mean difference in midline shift (range) was −2.64 ± 2.73 (0–11) mm. These data indicate marked short-term volumetric changes and support the role of an MRI to aid in target volume delineation as close to radiation treatment start as possible. Planning adapted to the actual anatomy at the time of radiation limits the risk of geographic miss and might thus improve outcomes in patients undergoing adjuvant radiation for high-grade glioma. |
format | Online Article Text |
id | pubmed-10216722 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102167222023-05-27 Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma Dejonckheere, Cas Stefaan Thelen, Anja Simon, Birgit Greschus, Susanne Köksal, Mümtaz Ali Schmeel, Leonard Christopher Wilhelm-Buchstab, Timo Leitzen, Christina Cancers (Basel) Article SIMPLE SUMMARY: Malignant brain tumours have a poor prognosis and routinely require brain surgery followed by radiation treatment of the extended tumour cavity. We compared magnetic resonance images (MRIs) of 28 patients at two points in time: immediately after surgery and close before the start of radiation. Even though both MRIs were roughly only 3 weeks apart, we noted substantial differences in the position and size of the tumour cavity, surrounding affected brain tissue, the position of the midline, and bleeding in the surgical area. The brain anatomy, as seen in the MRI, guides the planning of radiation. Older images thus do not reflect the actual anatomy anymore, which might lead to insufficient treatment of the tumour site or increased side effects due to irradiation of healthy tissues. Our data support the use of a second MRI for radiation treatment planning as close to its start as possible. ABSTRACT: High-grade glioma has a poor prognosis, and radiation therapy plays a crucial role in its management. Every step of treatment planning should thus be optimised to maximise survival chances and minimise radiation-induced toxicity. Here, we compare structures needed for target volume delineation between an immediate postoperative magnetic resonance imaging (MRI) and a radiation treatment planning MRI to establish the need for the latter. Twenty-eight patients were included, with a median interval between MRIs (range) of 19.5 (8–50) days. There was a mean change in resection cavity position (range) of 3.04 ± 3.90 (0–22.1) mm, with greater positional changes in skull-distant (>25 mm) resection cavity borders when compared to skull-near (≤25 mm) counterparts (p < 0.001). The mean differences in resection cavity and surrounding oedema and FLAIR hyperintensity volumes were −32.0 ± 29.6% and −38.0 ± 25.0%, respectively, whereas the mean difference in midline shift (range) was −2.64 ± 2.73 (0–11) mm. These data indicate marked short-term volumetric changes and support the role of an MRI to aid in target volume delineation as close to radiation treatment start as possible. Planning adapted to the actual anatomy at the time of radiation limits the risk of geographic miss and might thus improve outcomes in patients undergoing adjuvant radiation for high-grade glioma. MDPI 2023-05-19 /pmc/articles/PMC10216722/ /pubmed/37345177 http://dx.doi.org/10.3390/cancers15102840 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Dejonckheere, Cas Stefaan Thelen, Anja Simon, Birgit Greschus, Susanne Köksal, Mümtaz Ali Schmeel, Leonard Christopher Wilhelm-Buchstab, Timo Leitzen, Christina Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma |
title | Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma |
title_full | Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma |
title_fullStr | Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma |
title_full_unstemmed | Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma |
title_short | Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma |
title_sort | impact of postoperative changes in brain anatomy on target volume delineation for high-grade glioma |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216722/ https://www.ncbi.nlm.nih.gov/pubmed/37345177 http://dx.doi.org/10.3390/cancers15102840 |
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