Abstract
PurposeAmong the components of the central nervous system, the optic nerve and the brainstem are considered to be the eloquent structures that are sensitive to stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). SRS or SRT with fractionation in areas adjacent to these tissues is both promising and challenging.Materials and methodsTo clarify the precise dose distribution achievable with fractionation in and around the optic nerve and brainstem, theoretical simulations were performed, based on the biological effective dose (BED).ResultsThese simulations clearly showed that the doses to the optic nerve and brainstem can be adjusted using fractionation, meaning that the prescribed doses to the surrounding brain tissue can be reduced. Conversely doses to the lesions themselves can be increased by fractionation, while maintaining a stable dose to normal optic nerve and brainstem tissue.
Highlights
Radiosurgery has been established as one of the main treatment strategies for various brain lesions such as arteriovenous malformation (AVM), and both benign and malignant brain tumors as well as functional diseases such as trigeminal neuralgia, movement disorders and epilepsy
To clarify the precise dose distribution achievable with fractionation in and around the optic nerve and brainstem, theoretical simulations were performed, based on the biological effective dose (BED). These simulations clearly showed that the doses to the optic nerve and brainstem can be adjusted using fractionation, meaning that the prescribed doses to the surrounding brain tissue can be reduced
Doses to the lesions themselves can be increased by fractionation, while maintaining a stable dose to normal optic nerve and brainstem tissue
Summary
Radiosurgery has been established as one of the main treatment strategies for various brain lesions such as arteriovenous malformation (AVM), and both benign and malignant brain tumors as well as functional diseases such as trigeminal neuralgia, movement disorders and epilepsy. There are several obstacles to performing radiosurgery for the lesions in and around eloquent structures and for the lesions with large volumes. Some lesions in these locations can be treated with stereotactic radio surgery (SRS) or stereotactic radiotherapy (SRT). Brain lesions in and around the optic nerve and brainstem are believed to be sensitive to the dose distribution. It seems to be extremely difficult to perform microsurgery without any troubles for the lesions in and around both locations. In this study, fractionated treatments for the lesions in and the around optic apparatus and brainstem will be estimated in order to obtain ideal dose distributions capable of excellent clinical results and no comorbidities. The most adequate and precise dose distributions are searched with simulation methods based on the biological effective dose (BED)
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