Abstract
BackgroundRadiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined.MethodsDuring January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis.ResultsAmong the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively.ConclusionsBrainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. Dmax of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.
Highlights
Nasopharyngeal carcinoma (NPC) is a common malignancy in southern China, with an incidence of 5.38–11.16 per 100,000 people [1, 2]
A retrospective study showed that only 0.13–2.8% [10,11,12] of patients with nasopharyngeal carcinoma (NPC) developed brainstem necrosis after Intensity-modulated radiotherapy (IMRT)
Patients in stages T3 and T4 accounted for 68.48% (n = 328) of all patients included in the dosimetric analysis
Summary
Nasopharyngeal carcinoma (NPC) is a common malignancy in southern China, with an incidence of 5.38–11.16 per 100,000 people [1, 2]. With the prolonged survival time after radiotherapy, more and more late complications are worthy of attention. Fan et al BMC Cancer (2022) 22:178 survival, radiation-induced nerve injury could directly influence the quality of life [8]. Radiationinduced brain necrosis(RIBN) is a late life-threatening complication, which can appear after treatment. A retrospective study showed that only 0.13–2.8% [10,11,12] of patients with NPC developed brainstem necrosis after IMRT. RIBN is a late complication with low incidence but still worth of attention. Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). The relationship between RIBN and radiation dose is not still well-defined
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