Abstract
The purpose of our study was to examine the integration of functional MRI (fMRI) information into 3D based planning process of the central nervous system (CNS) malignancies. Between 01.01.2008 and 01.12.2008 four patients with astrocytoma were enrolled to this study. Before the planning process conventional planning CT, postoperative MR and individual functional MRI examinations were delivered. For the functional MRI examination the following four types of stimulus were applied: acoustic, visual, somatosensory and numeral. Three different theoretical planning situations were applied and compared: 3D conformal plan without fMRI information, 3D conformal plan with fMRI information and IMRT plan with fMRI information. For plan comparison DVH analysis, and NTCP model were used. fMRI based OR definition resulted in 4 additional OR’s in the contouring process. As these cases demonstrate, an average of 50% dose reduction was achieved in OR, OR2 and OR3 with IMRT and fMRI based 3D planning, especially in case of midline localization and big tumor extent. IMRT provides additional sparing effect in the optic tract and brainstem, especially for localizations close to the midline. Our results demonstrated that using fMRI information in conventional 3D based treatment planning potentially benefits significant dose reduction in critical organs, with no compromise in PTV coverage. fMRI can be widely used even in low grade cases (long life expectancies, lower acute and late toxicity in radiotherapy) and in cases with high grade astrocytomas or metastases (higher dose to PTV with better risk organ sparing in radiotherapy).
Similar content being viewed by others
References
Alvarez R, Liney G, Beavis A (2006) Repeatability of Functional MRI for Conformal Avoidance Radiotherapy Planning. J Magn Reson Imaging 23:108–114
Aoyama H, Kamada K, Shirato H et al (2004) Integration of mfunctional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography. Int J Radiat Oncol Biol Phys 58:1177–1183
Bleehen NM, Stenning SP (1991) A medical research council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. Br J Cancer 64:769–774
Burman C, Kutcher GJ, Emami B, Goitein M (1991) Fitting of tissue tolerance data to analytic function: improving the therapeutic ratio. Int J Radiat Oncol Biol Phys 21:123–135
Chang J, Kowalski A, Hou B, Narayana A (2008) Feasibility Study of Intensity-Modulated Radiotherapy (IMRT) treatment planning using brain functional MRI. Med Dosim 33(1):42–47
Clark BG et al (1998) The integral biologically effective dose to predict brain stem toxicity of hypofractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 40:667–675
Emami B et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122
Flickinger JC, Kondziolka D, Lunsford LD et al (2000) Development of a model to predict permanent symptomatic postradiosurgery. Int J Radiat Oncol Biol Phys 46:1143–1148
Jemal A, Murray T, Ward E et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55:10–30
Lee SW, Fraass BA, Marsh LH et al (1999) Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: a quantitative dosimetric study. Int J Radiat Oncol Biol Phys 43:79–88
Liu WC, Schulder M, Narra V et al (2000) Functional magnetic resonance imaging aided radiation treatment planning. Med Phys 27:1563–1572
Marks JE et al (1980) Cerebral radionecrosis: incidence and risk in relation to dose, time fractionation and volume. Int J Radiat Oncol Biol Phys 7:243–252
Moonen CTW, Bandettini PA (eds) (1999) Functional MRI1. Springer-Verlag, Berlin
Nelson DF, Diener-West M, Horton J et al (1988) Combined modality approach to treatment of malignant gliomas - Re-evaluation of RTOG 7401/ECOG 1374 with long-term follow-up: A joint study of the radiation therapy oncology group and the eastern cooperative oncology group. NCI Monogr 279–284
Rowinsky EK (1997) Paclitaxel pharmacology and other tumor types. Semin Oncol 24:S19-1–S19-12
Teh BS, Mai WY, Grant WH et al (2002) Intensity modulated radiotherapy (IMRT) decreases treatment-related morbidity and potentially enhances tumor control. Cancer Invest 20:437–451
Voges J, Treuer H, Sturm V et al (1996) Risk analysis of linear radiosurgery. Int J Radiat Oncol Biol Phys 36:1055–1063
Walker MD, Alexander E, Hunt WE et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. J Neurosurg 49:333–343
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kovács, Á., Tóth, L., Glavák, C. et al. Integrating Functional MRI Information into Radiotherapy Planning of CNS Tumors-Early Experiences. Pathol. Oncol. Res. 17, 207–217 (2011). https://doi.org/10.1007/s12253-010-9298-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12253-010-9298-y