Dosimetric analysis of radiation-induced brainstem necrosis for nasopharyngeal carcinoma treated with IMRT

Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and Decembe...

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Published inBMC cancer Vol. 22; no. 1; pp. 178 - 8
Main Authors Fan, Xigang, Huang, Yecai, Xu, Peng, Min, Yanmei, Li, Jie, Feng, Mei, Xu, Guohui, Lang, Jinyi
Format Journal Article
LanguageEnglish
Published London BioMed Central 17.02.2022
BioMed Central Ltd
BMC
Subjects
Adult
Biomedical and Life Sciences
Biomedicine
Brain Injuries - epidemiology
Brain Injuries - etiology
Brain Injuries - pathology
Brain stem
Brain Stem - pathology
Brainstem necrosis
Cancer Research
Cancer therapies
Care and treatment
Chemotherapy
Complications and side effects
Dosimetry
Endoscopy
Female
Health aspects
Health Promotion and Disease Prevention
Humans
Incidence
Intensity-modulated radiotherapy
Irritation
Logistic Models
Lymphatic system
Male
Medicine/Public Health
Methods
Middle Aged
Nasopharyngeal cancer
Nasopharyngeal carcinoma
Nasopharyngeal Carcinoma - radiotherapy
Nasopharyngeal Neoplasms - radiotherapy
Necrosis
Normal distribution
Oncology
Patients
Planning
Radiation Injuries - epidemiology
Radiation Injuries - etiology
Radiation Injuries - pathology
Radiation therapy
Radiometry
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated - adverse effects
Retrospective Studies
Risk factors
ROC Curve
Surgical Oncology
Throat cancer
Tolerance dose
China
United States > US
Nasopharyngeal carcinoma
Tolerance dose
Intensity-modulated radiotherapy
Brainstem necrosis
Online AccessGet full text
ISSN1471-2407
1471-2407
DOI10.1186/s12885-022-09213-z

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Abstract Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, D max (the maximum dose), D 0.1c (maximum average dose delivered to a 0.1-cc volume), D 1cc , D 2cc , D 3cc , D 5cc , D 10cc and D mean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Results Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of D max was the largest (0.987). Moreover, logistic stepwise regression indicated that D max was the most important dose factor. The RIBN incidence at 5% over 5 years (TD 5/5 ) and 50% incidence over 5 years (TD 50/5 ) was 69.59 Gy and76.45 Gy, respectively. Conclusions Brainstem necrosis is associated with high dose irritation. D max is the most significant predictive dosimetric factor for RIBN. D max of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was D max  < 69.59 Gy.
AbstractList Abstract Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Results Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively. Conclusions Brainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. D max of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.
Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Results Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively. Conclusions Brainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. Dmax of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.
Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, D.sub.max(the maximum dose), D.sub.0.1c (maximum average dose delivered to a 0.1-cc volume), D.sub.1cc, D.sub.2cc, D.sub.3cc, D.sub.5cc, D.sub.10cc and D.sub.mean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Results Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18-48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of D.sub.max was the largest (0.987). Moreover, logistic stepwise regression indicated that D.sub.max was the most important dose factor. The RIBN incidence at 5% over 5 years (TD.sub.5/5) and 50% incidence over 5 years (TD.sub.50/5) was 69.59 Gy and76.45 Gy, respectively. Conclusions Brainstem necrosis is associated with high dose irritation. D.sub.max is the most significant predictive dosimetric factor for RIBN. D.sub.max of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was D.sub.max < 69.59 Gy. Keywords: Brainstem necrosis, Tolerance dose, Nasopharyngeal carcinoma, Intensity-modulated radiotherapy
Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, D.sub.max(the maximum dose), D.sub.0.1c (maximum average dose delivered to a 0.1-cc volume), D.sub.1cc, D.sub.2cc, D.sub.3cc, D.sub.5cc, D.sub.10cc and D.sub.mean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18-48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of D.sub.max was the largest (0.987). Moreover, logistic stepwise regression indicated that D.sub.max was the most important dose factor. The RIBN incidence at 5% over 5 years (TD.sub.5/5) and 50% incidence over 5 years (TD.sub.50/5) was 69.59 Gy and76.45 Gy, respectively. Brainstem necrosis is associated with high dose irritation. D.sub.max is the most significant predictive dosimetric factor for RIBN. D.sub.max of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was D.sub.max < 69.59 Gy.
Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined.BACKGROUNDRadiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined.During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis.METHODSDuring January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis.Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18-48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively.RESULTSAmong the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18-48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively.Brainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. Dmax of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.CONCLUSIONSBrainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. Dmax of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.
Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. Methods During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, D max (the maximum dose), D 0.1c (maximum average dose delivered to a 0.1-cc volume), D 1cc , D 2cc , D 3cc , D 5cc , D 10cc and D mean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Results Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of D max was the largest (0.987). Moreover, logistic stepwise regression indicated that D max was the most important dose factor. The RIBN incidence at 5% over 5 years (TD 5/5 ) and 50% incidence over 5 years (TD 50/5 ) was 69.59 Gy and76.45 Gy, respectively. Conclusions Brainstem necrosis is associated with high dose irritation. D max is the most significant predictive dosimetric factor for RIBN. D max of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was D max  < 69.59 Gy.
Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined. During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, D (the maximum dose), D (maximum average dose delivered to a 0.1-cc volume), D , D , D , D , D and D (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis. Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18-48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of D was the largest (0.987). Moreover, logistic stepwise regression indicated that D was the most important dose factor. The RIBN incidence at 5% over 5 years (TD ) and 50% incidence over 5 years (TD ) was 69.59 Gy and76.45 Gy, respectively. Brainstem necrosis is associated with high dose irritation. D is the most significant predictive dosimetric factor for RIBN. D of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was D  < 69.59 Gy.
ArticleNumber 178
Audience Academic
Author Xu, Peng
Xu, Guohui
Min, Yanmei
Lang, Jinyi
Li, Jie
Fan, Xigang
Feng, Mei
Huang, Yecai
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Issue 1
Keywords Nasopharyngeal carcinoma
Tolerance dose
Intensity-modulated radiotherapy
Brainstem necrosis
Language English
License 2022. The Author(s).
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Snippet Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal...
Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma...
Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal...
Abstract Background Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with...
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SubjectTerms Adult
Biomedical and Life Sciences
Biomedicine
Brain Injuries - epidemiology
Brain Injuries - etiology
Brain Injuries - pathology
Brain stem
Brain Stem - pathology
Brainstem necrosis
Cancer Research
Cancer therapies
Care and treatment
Chemotherapy
Complications and side effects
Dosimetry
Endoscopy
Female
Health aspects
Health Promotion and Disease Prevention
Humans
Incidence
Intensity-modulated radiotherapy
Irritation
Logistic Models
Lymphatic system
Male
Medicine/Public Health
Methods
Middle Aged
Nasopharyngeal cancer
Nasopharyngeal carcinoma
Nasopharyngeal Carcinoma - radiotherapy
Nasopharyngeal Neoplasms - radiotherapy
Necrosis
Normal distribution
Oncology
Patients
Planning
Radiation Injuries - epidemiology
Radiation Injuries - etiology
Radiation Injuries - pathology
Radiation therapy
Radiometry
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated - adverse effects
Retrospective Studies
Risk factors
ROC Curve
Surgical Oncology
Throat cancer
Tolerance dose
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Title Dosimetric analysis of radiation-induced brainstem necrosis for nasopharyngeal carcinoma treated with IMRT
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