Brain Radiation Necrosis Outside the Target Volume After Proton Radiation Therapy: Analyses of Multiparametric Imaging and Proton Biologic Effectiveness

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dc.citation.articleNumber101044en_US
dc.citation.issueNumber6en_US
dc.citation.journalTitleAdvances in Radiation Oncologyen_US
dc.citation.volumeNumber7en_US
dc.contributor.authorBronk, Julianna K.en_US
dc.contributor.authorAmer, Ahmaden_US
dc.contributor.authorKhose, Swapnilen_US
dc.contributor.authorFlint, Daviden_US
dc.contributor.authorAdair, Antonyen_US
dc.contributor.authorYepes, Pabloen_US
dc.contributor.authorGrosshans, Daviden_US
dc.contributor.authorJohnson, Jasonen_US
dc.contributor.authorChung, Carolineen_US
dc.date.accessioned2022-09-29T15:06:22Zen_US
dc.date.available2022-09-29T15:06:22Zen_US
dc.date.issued2022en_US
dc.description.abstractPurpose We present the case of a 48-year-old patient with recurrent World Health Organization grade II meningioma in the left occipital region who underwent a subtotal resection, followed by postoperative proton therapy to residual disease and the resection cavity. Fourteen months after radiation treatment completion, surveillance imaging revealed numerous ring-enhancing infratentorial lesions, both within and outside of the high-dose field, of concern for viable tumor. We describe the use of advanced imaging and proton biologic effectiveness analyses to enable the diagnosis of radiation necrosis (RN) and ascertain intrinsic physical factors contributing to the development of RN in this patient. Methods and Materials Multiparametric magnetic resonance imaging (MRI) and Monte Carlo predictions of linear energy transfer (LET) and variable relative biologic effectiveness dose were performed. Results The dosimetric analysis revealed that of the 10 lesions, 9 were located outside of the clinical treatment volume and 6 received a dose of <60 Gy relative biologic effectiveness to 95% of the volume. However, increased proton LET values were found in lesions that received lower radiation doses. Dynamic susceptibility contrast and contrast-enhanced, as well as arterial spin labeling-perfusion MRI findings were consistent with RN. Subsequent follow-up imaging revealed no further progression, and the patient was disease-free at the time of this report. Conclusions We describe a case of brain RN after proton beam radiation outside of the high-dose radiation therapy volume. On initial radiographic detection of these lesions, the distant relationship between their anatomic location with respect to the patient's treatment history reduced the suspicion of RN. However, on closer examination of intrinsic physical variables, RN lesions were present in regions that received a lower dose but higher LETs. Although conventional multisequence MRI was inadequate to distinguish between RN and tumor progression, characterization of tissue physiology allowed for the correct diagnosis, highlighting the utility of advanced brain tumor imaging in the follow-up setting.en_US
dc.identifier.citationBronk, Julianna K., Amer, Ahmad, Khose, Swapnil, et al.. "Brain Radiation Necrosis Outside the Target Volume After Proton Radiation Therapy: Analyses of Multiparametric Imaging and Proton Biologic Effectiveness." <i>Advances in Radiation Oncology,</i> 7, no. 6 (2022) Elsevier: https://doi.org/10.1016/j.adro.2022.101044.en_US
dc.identifier.digital1-s2-0-S2452109422001506-mainen_US
dc.identifier.doihttps://doi.org/10.1016/j.adro.2022.101044en_US
dc.identifier.urihttps://hdl.handle.net/1911/113420en_US
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.rightsThis is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).en_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/).en_US
dc.titleBrain Radiation Necrosis Outside the Target Volume After Proton Radiation Therapy: Analyses of Multiparametric Imaging and Proton Biologic Effectivenessen_US
dc.typeJournal articleen_US
dc.type.dcmiTexten_US
dc.type.publicationpublisher versionen_US
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