Analysis of MRI volumetric changes after hypofractionated stereotactic radiation therapy for benign intracranial neoplasms

Kathryn R. Fega, Geoffrey P. Fletcher, Mark R. Waddle, Jennifer L. Peterson, Jonathan B. Ashman, David M. Barrs, Bernard Bendok, Naresh Patel, Alyx B Porter Umphrey, Sujay A. Vora

Research output: Contribution to journalArticle

Abstract

Purpose: To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials: We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results: Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). Conclusions: HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist's interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.

Original languageEnglish (US)
JournalAdvances in Radiation Oncology
DOIs
StateAccepted/In press - Jan 1 2018

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Brain Neoplasms
Radiotherapy
Magnetic Resonance Imaging
Acoustic Neuroma
Meningioma
Neoplasms
Tumor Burden
Incidence

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Fega, K. R., Fletcher, G. P., Waddle, M. R., Peterson, J. L., Ashman, J. B., Barrs, D. M., ... Vora, S. A. (Accepted/In press). Analysis of MRI volumetric changes after hypofractionated stereotactic radiation therapy for benign intracranial neoplasms. Advances in Radiation Oncology. https://doi.org/10.1016/j.adro.2018.08.013

Analysis of MRI volumetric changes after hypofractionated stereotactic radiation therapy for benign intracranial neoplasms. / Fega, Kathryn R.; Fletcher, Geoffrey P.; Waddle, Mark R.; Peterson, Jennifer L.; Ashman, Jonathan B.; Barrs, David M.; Bendok, Bernard; Patel, Naresh; Porter Umphrey, Alyx B; Vora, Sujay A.

In: Advances in Radiation Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Fega, Kathryn R. ; Fletcher, Geoffrey P. ; Waddle, Mark R. ; Peterson, Jennifer L. ; Ashman, Jonathan B. ; Barrs, David M. ; Bendok, Bernard ; Patel, Naresh ; Porter Umphrey, Alyx B ; Vora, Sujay A. / Analysis of MRI volumetric changes after hypofractionated stereotactic radiation therapy for benign intracranial neoplasms. In: Advances in Radiation Oncology. 2018.
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abstract = "Purpose: To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials: We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results: Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4{\%} for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50{\%}) with vestibular schwannoma and 2 (22{\%}) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85{\%}). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20{\%} (n = 24 [13{\%}]). Conclusions: HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist's interpretation generally agreed with the volumetric MRI measurement, the overall 15{\%} discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.",
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AU - Fega, Kathryn R.

AU - Fletcher, Geoffrey P.

AU - Waddle, Mark R.

AU - Peterson, Jennifer L.

AU - Ashman, Jonathan B.

AU - Barrs, David M.

AU - Bendok, Bernard

AU - Patel, Naresh

AU - Porter Umphrey, Alyx B

AU - Vora, Sujay A.

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Y1 - 2018/1/1

N2 - Purpose: To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials: We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results: Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). Conclusions: HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist's interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.

AB - Purpose: To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials: We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results: Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). Conclusions: HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist's interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.

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