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Dose–Volume Relationships Associated With Temporal Lobe Radiation Necrosis After Skull Base Proton Beam Therapy  Mark W. McDonald, MD, Okechukwu R. Linton,

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Presentation on theme: "Dose–Volume Relationships Associated With Temporal Lobe Radiation Necrosis After Skull Base Proton Beam Therapy  Mark W. McDonald, MD, Okechukwu R. Linton,"— Presentation transcript:

1 Dose–Volume Relationships Associated With Temporal Lobe Radiation Necrosis After Skull Base Proton Beam Therapy  Mark W. McDonald, MD, Okechukwu R. Linton, MD, MBA, Cynthia S.J. Calley, MA  International Journal of Radiation Oncology • Biology • Physics  Volume 91, Issue 2, Pages (February 2015) DOI: /j.ijrobp Copyright © 2015 Elsevier Inc. Terms and Conditions

2 Fig. 1 An example of radiation necrosis in a patient treated for a clival chordoma. The left panel shows the presenting magnetic resonance imaging (MRI) with a clival and suprasellar T2 hyperintense tumor with bilateral cavernous sinus involvement and significant brainstem compression. The middle 2 panels show an axial and coronal image of the foci of asymptomatic radiation necrosis that developed in the left temporal lobe. MRI perfusion and spectroscopy were supportive of a diagnosis of radiation necrosis. Encephalomacia is noted in the right temporal lobe from prior surgery. The right panel shows the prior radiation dose superimposed on the MRI demonstrating radiation necrosis, which is transected by the prior 95% isodose line of therapy. Of note, based on its location at the time of treatment planning MRI, the maximum surface dose to the brainstem was 63 Gy (relative biological effectiveness). The patient remains without evidence of recurrent disease 3 years after radiation therapy. After initiation of pentoxifylline and Vitamin E, the area resolved on follow-up MRI. International Journal of Radiation Oncology • Biology • Physics  , DOI: ( /j.ijrobp ) Copyright © 2015 Elsevier Inc. Terms and Conditions

3 Fig. 2 Mean dose–volume histogram for temporal lobes with and without radiation necrosis (any grade). The 95% confidence intervals for the mean of each curve are shown by the dashed lines. International Journal of Radiation Oncology • Biology • Physics  , DOI: ( /j.ijrobp ) Copyright © 2015 Elsevier Inc. Terms and Conditions

4 Fig. 3 Median effective concentration volume risk analysis for temporal lobe radiation necrosis (any grade). Each curve is labeled for the absolute volume of temporal lobe exposed to a dose level in Gy (relative biological effectiveness). International Journal of Radiation Oncology • Biology • Physics  , DOI: ( /j.ijrobp ) Copyright © 2015 Elsevier Inc. Terms and Conditions

5 Fig. 4 Absolute dose–absolute volume histogram curve predicted to have a 15% risk of any grade temporal lobe radiation necrosis. International Journal of Radiation Oncology • Biology • Physics  , DOI: ( /j.ijrobp ) Copyright © 2015 Elsevier Inc. Terms and Conditions

6 Fig. 5 Semilog graph of the correlation between the absolute volume (aV) of temporal lobe receiving 40 Gy (y axis) and 70 Gy (x axis) for temporal lobes with and without subsequent development of any-grade radiation necrosis. Spearman rank-order correlation coefficient between aV40 and aV70 was 0.82, P<.01. International Journal of Radiation Oncology • Biology • Physics  , DOI: ( /j.ijrobp ) Copyright © 2015 Elsevier Inc. Terms and Conditions

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