Impact of PTV Margin Reduction (2 mm to 0 mm) on Pseudoprogression in Stereotactic Radiotherapy of Solitary Brain Metastases

Overview

Journal Tech Innov Patient Support Radiat Oncol

Date 2021 May 19

PMID 34007906

Citations 4

Authors

Justine Badloe

Mirjam Mast

Anna Petoukhova

Jan-Huib Franssen

Elyas Ghariq

Noelle van der Voort van Zijp

Ruud Wiggenraad

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the influence of PTV-margin (0 mm versus 2 mm) on the incidence of pseudoprogression (PP) and local tumour control (LC) in patients treated with stereotactic radiotherapy (SRT) for solitary brain metastases.

Methods: Patients were treated on Novalis LINAC. Three dose schedules were used depending on the PTV-size. The PTV-margin was 2-mm prior to 2015 and 0-mm thereafter. MRI-scans were made every three months including a perfusion MRI-scan when pseudoprogression was suspected. We examined the relation of pseudoprogression and local control with the size of PTV-margin. Besides this, the association of dose-volume data of the whole brain (minus GTV) and pseudoprogression was investigated.

Results: 121 patients were analyzed (2-mm margin in 84 patients; 0-mm margin in 37 patients). There was no difference in GTV (7.6 cc versus 9.1 cc p = 0.2). At 24 months there was no difference in incidence of pseudoprogression (49% and versus 33%, p = 0.5) and local control in the 2-mm and 0-mm group (82% and versus 79%, p = 1.0). The size of PTV-margin was not associated with PP. Both margin and volume of brain receiving 12 Gy (V12) were not associated with pseudoprogression in patients treated with single fraction.

Conclusions: PTV-margin reduction did not reduce the incidence of pseudoprogression in LINAC-based-SRT for single brain metastases. We did not find a significant association of GTV-PTV margin or V12Gy with the incidence of pseudoprogression in solitary metastases treated with a single fraction. LC rates were similar, indicating margin reduction seems to be safe.

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Impact of PTV Margin Reduction (2 mm to 0 mm) on Pseudoprogression in Stereotactic Radiotherapy of Solitary Brain Metastases

Impact of PTV Margin Reduction (2 mm to 0 mm) on Pseudoprogression in Stereotactic Radiotherapy of Solitary Brain Metastases