AI Article Synopsis
- The study focuses on the importance of accurately contouring the brachial plexus (BP) to assess toxicity and identify metrics for predicting radiation-induced brachial plexopathy (RIBP) after targeted radiotherapy.
- Patients with a specific planning target volume (PTV) close to the BP were analyzed, using established radiation therapy atlases for contouring.
- Results showed that maximum doses to the BP were linked to a significant risk of RIBP, highlighting that relying on subclavian-axillary veins for dosimetry may underestimate risk, especially in certain patient groups.
Article Abstract
Objectives: Examine the significance of contouring the brachial plexus (BP) for toxicity estimation and select metrics for predicting radiation-induced brachial plexopathy (RIBP) after stereotactic body radiotherapy.
Materials And Methods: Patients with planning target volume (PTV) ≤ 2 cm from the BP were eligible. The BP was contoured primarily according to the RTOG 1106 atlas, while subclavian-axillary veins (SAV) were contoured according to RTOG 0236. Apical PTVs were classified as anterior (PTV-A) or posterior (PTV-B) PTVs. Variables predicting grade 2 or higher RIBP (RIBP2) were selected through least absolute shrinkage and selection operator regression and logistic regression.
Results: Among 137 patients with 140 BPs (median follow-up, 32.1 months), 11 experienced RIBP2. For patients with RIBP2, the maximum physical dose to the BP (BP-D) was 46.5 Gy (median; range, 35.7 to 60.7 Gy). Of these patients, 54.5 % (6/11) satisfied the RTOG limits when using SAV delineation; among them, 83.3 % (5/6) had PTV-B. For patients with PTV-B, the maximum physical dose to SAV (SAV-D) was 11.2 Gy (median) lower than BP-D. Maximum and 0.3 cc biologically effective doses to the BP based on the linear-quadratic-linear model (BP-BED and BP-BED, α/β = 3) were selected as predictive variables with thresholds of 118 and 73 Gy, respectively.
Conclusion: Contouring SAV may significantly underestimate the RIBP2 risk in dosimetry, especially for patients with PTV-B. BP contouring indicated BP-BED and BP-BED as potential predictors of RIBP2.
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| http://dx.doi.org/10.1016/j.radonc.2023.110023 | DOI Listing |
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