RADT-36. FUNCTION-ADAPTED RADIOTHERAPY PLANNING IN THE MANAGEMENT OF HIGH-GRADE GLIOMAS: A COMPARING STUDY FOR DOSE SPARING OF SPEECH-ELOQUENT BRAIN AREAS

Abstract

Abstract BACKGROUND Radiotherapy (RT) for brain tumors can induce injury of functional white matter tracts. In neurosurgery navigated transcranial magnetic stimulation (nTMS)- and diffusion tensor imaging (DTI)-based fiber tracts (FT) is an established tool to protect functional FT during tumor resection. We investigated it´s applicability in RT planning with the aim of dose reduction of language-associated fiber tracts. METHODS Preoperative, nTMS-generated and DTI-based FT of the functional left hemispheric language network of patients with language-eloquent malignant gliomas (WHO III/IV) were imported into the planning software (ARIA®) according to the DICOM standard and contoured as a risk structure. Brain shift after tumor resection was compensated using elastic fusion (Brainlab®). The treatment plans were optimized or recalculated with the aim of reducing the dose to the fiber tracts outside the planning target volume (PTV). The dosimetric evaluation was performed according to dose volume histogram parameters. RESULTS RT plans of 27 patients were retrospectively evaluated in the study. The mean dose (Dmean) to the fiber tracts was 37.3+/-11.8 Gy, with plan optimization dose was 33.6 +/- 12.2 Gy (-10.9% p<0.01), within the 20 Gy isodose the dose reduction to be achieved was on average - 25.0% (range 0-48.5%). The V54Gy and V20Gy were on average 40.2 +/- 23.7% and 72.3 +/- 21.1% compared to 38.2 +/- 23.5% and 58.1 +/- 23.7% (both p<0.01) with optimization. The Dmean of the PTV did not change (59.8 Gy vs. 59.8 Gy (p=0.5)), nor did the dose homogeneity (HI, (D5-D95)/Dp)(p=0.63)). The dose exposure of the organs at risk was within the specified dose constraints. CONCLUSION This study showed that (nTMS)- and diffusion tensor imaging (DTI)-based fiber tractography could be used in radiotherapy planning to spare language-eloquent brain areas without having to accept dose reductions within the PTV. Whether the concept of tract-based sparing of language function brings clinical benefits to patients needs to be further investigated in prospective studies.