Reirradiation tolerance of the human brain

Ramona Mayer, Peter Sminia

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

PURPOSE: To give an overview of current available clinical data on reirradiation of glioma with respect to the tolerance dose of normal brain tissue.

METHODS AND MATERIALS: Clinical brain reirradiation studies from January 1996 to December 2006 were considered on radiation-induced late adverse effects-i.e., brain tissue necrosis. The studies were analyzed by using the linear quadratic model to derive information on the cumulative biologic effective tolerance dose (BED(cumulative)) and equivalent doses in 2-Gy fractions (normalized total doses, NTD(cumulative)) for the healthy human brain.

RESULTS: The NTD(cumulative) in conventional reirradiation series (NTD(cumulative) of 81.6-101.9 Gy) were generally lower than in fractionated stereotactic radiotherapy (FSRT) (NTD(cumulative) of 90-133.9 Gy.) or LINAC-based stereotactic radiosurgery series (NTD(cumulative) of 111.6-137.2 Gy). No correlation between the time interval between the initial and reirradiation course and the incidence of radionecrosis was noted. The analysis showed the prescribed NTD(cumulative) to increase with decreasing treatment volume, which is allowed by modern conformal radiation techniques.

CONCLUSION: Radiation-induced normal brain tissue necrosis is found to occur at NTD(cumulative) >100 Gy. The applied reirradiation dose and NTD(cumulative) increases with a change in irradiation technique from conventional to radiosurgery re-treatment, without increasing the probability of normal brain necrosis. Taken together, modern conformal treatment options, because of their limited volume of normal brain tissue exposure, allow brain reirradiation for palliative treatment of recurrent high grade glioma with an acceptable probability of radionecrosis.

Original languageEnglish
Pages (from-to)1350-1360
Number of pages11
JournalInternational journal of radiation oncology, biology, physics
Volume70
Issue number5
DOIs
Publication statusPublished - 1 Apr 2008

Cite this

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title = "Reirradiation tolerance of the human brain",
abstract = "PURPOSE: To give an overview of current available clinical data on reirradiation of glioma with respect to the tolerance dose of normal brain tissue.METHODS AND MATERIALS: Clinical brain reirradiation studies from January 1996 to December 2006 were considered on radiation-induced late adverse effects-i.e., brain tissue necrosis. The studies were analyzed by using the linear quadratic model to derive information on the cumulative biologic effective tolerance dose (BED(cumulative)) and equivalent doses in 2-Gy fractions (normalized total doses, NTD(cumulative)) for the healthy human brain.RESULTS: The NTD(cumulative) in conventional reirradiation series (NTD(cumulative) of 81.6-101.9 Gy) were generally lower than in fractionated stereotactic radiotherapy (FSRT) (NTD(cumulative) of 90-133.9 Gy.) or LINAC-based stereotactic radiosurgery series (NTD(cumulative) of 111.6-137.2 Gy). No correlation between the time interval between the initial and reirradiation course and the incidence of radionecrosis was noted. The analysis showed the prescribed NTD(cumulative) to increase with decreasing treatment volume, which is allowed by modern conformal radiation techniques.CONCLUSION: Radiation-induced normal brain tissue necrosis is found to occur at NTD(cumulative) >100 Gy. The applied reirradiation dose and NTD(cumulative) increases with a change in irradiation technique from conventional to radiosurgery re-treatment, without increasing the probability of normal brain necrosis. Taken together, modern conformal treatment options, because of their limited volume of normal brain tissue exposure, allow brain reirradiation for palliative treatment of recurrent high grade glioma with an acceptable probability of radionecrosis.",
keywords = "Brain/pathology, Brain Neoplasms/drug therapy, Glioma/drug therapy, Humans, Linear Models, Necrosis/etiology, Radiation Injuries/pathology, Radiation Tolerance, Radiosurgery/adverse effects, Radiotherapy Dosage, Relative Biological Effectiveness, Retreatment/adverse effects, Retrospective Studies, Time Factors",
author = "Ramona Mayer and Peter Sminia",
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day = "1",
doi = "10.1016/j.ijrobp.2007.08.015",
language = "English",
volume = "70",
pages = "1350--1360",
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}

Reirradiation tolerance of the human brain. / Mayer, Ramona; Sminia, Peter.

In: International journal of radiation oncology, biology, physics, Vol. 70, No. 5, 01.04.2008, p. 1350-1360.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Reirradiation tolerance of the human brain

AU - Mayer, Ramona

AU - Sminia, Peter

PY - 2008/4/1

Y1 - 2008/4/1

N2 - PURPOSE: To give an overview of current available clinical data on reirradiation of glioma with respect to the tolerance dose of normal brain tissue.METHODS AND MATERIALS: Clinical brain reirradiation studies from January 1996 to December 2006 were considered on radiation-induced late adverse effects-i.e., brain tissue necrosis. The studies were analyzed by using the linear quadratic model to derive information on the cumulative biologic effective tolerance dose (BED(cumulative)) and equivalent doses in 2-Gy fractions (normalized total doses, NTD(cumulative)) for the healthy human brain.RESULTS: The NTD(cumulative) in conventional reirradiation series (NTD(cumulative) of 81.6-101.9 Gy) were generally lower than in fractionated stereotactic radiotherapy (FSRT) (NTD(cumulative) of 90-133.9 Gy.) or LINAC-based stereotactic radiosurgery series (NTD(cumulative) of 111.6-137.2 Gy). No correlation between the time interval between the initial and reirradiation course and the incidence of radionecrosis was noted. The analysis showed the prescribed NTD(cumulative) to increase with decreasing treatment volume, which is allowed by modern conformal radiation techniques.CONCLUSION: Radiation-induced normal brain tissue necrosis is found to occur at NTD(cumulative) >100 Gy. The applied reirradiation dose and NTD(cumulative) increases with a change in irradiation technique from conventional to radiosurgery re-treatment, without increasing the probability of normal brain necrosis. Taken together, modern conformal treatment options, because of their limited volume of normal brain tissue exposure, allow brain reirradiation for palliative treatment of recurrent high grade glioma with an acceptable probability of radionecrosis.

AB - PURPOSE: To give an overview of current available clinical data on reirradiation of glioma with respect to the tolerance dose of normal brain tissue.METHODS AND MATERIALS: Clinical brain reirradiation studies from January 1996 to December 2006 were considered on radiation-induced late adverse effects-i.e., brain tissue necrosis. The studies were analyzed by using the linear quadratic model to derive information on the cumulative biologic effective tolerance dose (BED(cumulative)) and equivalent doses in 2-Gy fractions (normalized total doses, NTD(cumulative)) for the healthy human brain.RESULTS: The NTD(cumulative) in conventional reirradiation series (NTD(cumulative) of 81.6-101.9 Gy) were generally lower than in fractionated stereotactic radiotherapy (FSRT) (NTD(cumulative) of 90-133.9 Gy.) or LINAC-based stereotactic radiosurgery series (NTD(cumulative) of 111.6-137.2 Gy). No correlation between the time interval between the initial and reirradiation course and the incidence of radionecrosis was noted. The analysis showed the prescribed NTD(cumulative) to increase with decreasing treatment volume, which is allowed by modern conformal radiation techniques.CONCLUSION: Radiation-induced normal brain tissue necrosis is found to occur at NTD(cumulative) >100 Gy. The applied reirradiation dose and NTD(cumulative) increases with a change in irradiation technique from conventional to radiosurgery re-treatment, without increasing the probability of normal brain necrosis. Taken together, modern conformal treatment options, because of their limited volume of normal brain tissue exposure, allow brain reirradiation for palliative treatment of recurrent high grade glioma with an acceptable probability of radionecrosis.

KW - Brain/pathology

KW - Brain Neoplasms/drug therapy

KW - Glioma/drug therapy

KW - Humans

KW - Linear Models

KW - Necrosis/etiology

KW - Radiation Injuries/pathology

KW - Radiation Tolerance

KW - Radiosurgery/adverse effects

KW - Radiotherapy Dosage

KW - Relative Biological Effectiveness

KW - Retreatment/adverse effects

KW - Retrospective Studies

KW - Time Factors

U2 - 10.1016/j.ijrobp.2007.08.015

DO - 10.1016/j.ijrobp.2007.08.015

M3 - Review article

VL - 70

SP - 1350

EP - 1360

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -