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Keywords = radiosurgery boost

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14 pages, 667 KiB  
Article
MRI-Based Radiomics Ensemble Model for Predicting Radiation Necrosis in Brain Metastasis Patients Treated with Stereotactic Radiosurgery and Immunotherapy
by Yijun Chen, Corbin Helis, Christina Cramer, Michael Munley, Ariel Raimundo Choi, Josh Tan, Fei Xing, Qing Lyu, Christopher Whitlow, Jeffrey Willey, Michael Chan and Yuming Jiang
Cancers 2025, 17(12), 1974; https://doi.org/10.3390/cancers17121974 - 13 Jun 2025
Viewed by 561
Abstract
Background: Radiation therapy is a primary and cornerstone treatment modality for brain metastasis. However, it can result in complications like necrosis, which may lead to significant neurological deficits. This study aims to develop and validate an ensemble model with radiomics to predict radiation [...] Read more.
Background: Radiation therapy is a primary and cornerstone treatment modality for brain metastasis. However, it can result in complications like necrosis, which may lead to significant neurological deficits. This study aims to develop and validate an ensemble model with radiomics to predict radiation necrosis. Method: This study retrospectively collected and analyzed MRI images and clinical information from 209 stereotactic radiosurgery sessions involving 130 patients with brain metastasis. An ensemble model integrating gradient boosting, random forest, decision tree, and support vector machine was developed and validated using selected radiomic features and clinical factors to predict the likelihood of necrosis. The model performance was evaluated and compared with other machine learning algorithms using metrics, including the area under the curve (AUC), sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). SHapley Additive exPlanations (SHAP) analysis and local interpretable model-agnostic explanations (LIME) analysis were applied to explain the model’s prediction. Results: The ensemble model achieved strong performance in the validation cohort, with the highest AUC. Compared to individual models and the stacking ensemble model, it consistently outperformed. The model demonstrated superior accuracy, generalizability, and reliability in predicting radiation necrosis. SHAP and LIME were used to interpret a complex predictive model for radiation necrosis. Both analyses highlighted similar significant factors, enhancing our understanding of prediction dynamics. Conclusions: The ensemble model using radiomic features exhibited high accuracy and robustness in predicting the occurrence of radiation necrosis. It could serve as a novel and valuable tool to facilitate radiotherapy for patients with brain metastasis. Full article
(This article belongs to the Special Issue Brain Metastases: From Mechanisms to Treatment)
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13 pages, 2972 KiB  
Article
CyberKnife Ultra-Hypofractionated SBRT for Localized Prostate Cancer with Dose Escalation to the Dominant Intraprostatic Lesion: In Silico Planning Study
by Giovanni Carlo Mazzola, Maria Giulia Vincini, Elena Rondi, Giuseppe Ronci, Sabrina Vigorito, Mattia Zaffaroni, Giulia Corrao, Salvatore Gallo, Dario Zerini, Stefano Durante, Francesco Alessandro Mistretta, Stefano Luzzago, Matteo Ferro, Andrea Vavassori, Federica Cattani, Gennaro Musi, Ottavio De Cobelli, Giuseppe Petralia, Roberto Orecchia, Giulia Marvaso and Barbara Alicja Jereczek-Fossaadd Show full author list remove Hide full author list
Appl. Sci. 2023, 13(12), 7273; https://doi.org/10.3390/app13127273 - 19 Jun 2023
Cited by 1 | Viewed by 3200
Abstract
The aim is to evaluate the feasibility of ultra-hypofractionated (UH) SBRT with CyberKnife® (CK) radiosurgery (Accuray Inc., Sunnyvale, California, USA) for localized prostate cancer (PCa) with a concomitant focal boost to the dominant intraprostatic lesion (DIL). Patients with intermediate/high-risk PCa, with at [...] Read more.
The aim is to evaluate the feasibility of ultra-hypofractionated (UH) SBRT with CyberKnife® (CK) radiosurgery (Accuray Inc., Sunnyvale, California, USA) for localized prostate cancer (PCa) with a concomitant focal boost to the dominant intraprostatic lesion (DIL). Patients with intermediate/high-risk PCa, with at least one visible DIL on multi-parametric MRI, were included. For each, two CK-SBRT in silico plans were calculated using 95% and 85% isodose lines (CK-95%, CK-85%) and compared with the UH-DWA plan delivered with VERO®. All plans simulated a SIB prescription of 40 Gy to PTV-DIL and 36.25 Gy to the whole prostate (PTV-prostate) in five fractions every other day. Fifteen patients were considered. All plans reached the primary planning goal (D95% > 95%) and compliance with organs at risk (OARs) constraints. DVH metrics median values increased (p < 0.05) from UH-DWA to CK-85%. The conformity index of PTV-DIL was 1.00 for all techniques, while for PTV-prostate was 0.978, 0.984, and 0.991 for UH-DWA, CK-95%, and CK-85%, respectively. The CK-85% plans were able to reach a maximum dose of 47 Gy to the DIL while respecting OARs constraints. CK-SBRT plus a focal boost to the DIL for localized PCa appears to be feasible. These encouraging dosimetric results are to be confirmed in upcoming clinical trials such as the phase-II “PRO-SPEED” IEO trial. Full article
(This article belongs to the Special Issue Medical Physics: Latest Advances and Prospects)
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9 pages, 2203 KiB  
Case Report
Stereotactic Radiotherapy Boost in Treatment of Persistent Periocular Sebaceous Carcinoma after Surgery
by Paweł Polanowski, Aleksandra Nasiek, Aleksandra Grządziel, Ewa Chmielik, Agnieszka Pietruszka, Krzysztof Składowski and Katarzyna Polanowska
Biomedicines 2023, 11(6), 1538; https://doi.org/10.3390/biomedicines11061538 - 26 May 2023
Cited by 1 | Viewed by 1713
Abstract
Sebaceous carcinoma is a rare malignancy that should be treated with surgical resection. Nonetheless, a dynamic and aggressive course of the disease may disqualify a patient from this treatment. Applying radiotherapy with the escalation dose using a stereotactic boost is worthy of consideration [...] Read more.
Sebaceous carcinoma is a rare malignancy that should be treated with surgical resection. Nonetheless, a dynamic and aggressive course of the disease may disqualify a patient from this treatment. Applying radiotherapy with the escalation dose using a stereotactic boost is worthy of consideration as a radical treatment. In this paper, we present the case study of a young patient with a tumor localized in the periocular area. The patient was treated with operation two times without a satisfactory effect. Conventional radiotherapy, 60 Gy in 30 fractions, combined with chemotherapy based on cisplatin 40 mg/m2 and the addition of a stereotactic radiosurgery boost were administered. The tolerance of this treatment was acceptable. During the 2-year follow-up, local and distant recurrences were not diagnosed. The presented case shows the usefulness of an individualized approach in the radical treatment of sebaceous carcinoma with the use of the stereotactic radiotherapy boost. This is a subsequent example of the implementation of the boost in head and neck carcinoma, which yields a positive result. Full article
(This article belongs to the Special Issue State-of-the-Art Cancer Biology and Therapeutics in Poland Volume II)
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11 pages, 769 KiB  
Article
Development of Predictive Models for the Response of Vestibular Schwannoma Treated with Cyberknife®: A Feasibility Study Based on Radiomics and Machine Learning
by Isa Bossi Zanetti, Elena De Martin, Riccardo Pascuzzo, Natascha Claudia D’Amico, Sara Morlino, Irene Cane, Domenico Aquino, Marco Alì, Michaela Cellina, Giancarlo Beltramo and Laura Fariselli
J. Pers. Med. 2023, 13(5), 808; https://doi.org/10.3390/jpm13050808 - 10 May 2023
Cited by 6 | Viewed by 2611
Abstract
Purpose: to predict vestibular schwannoma (VS) response to radiosurgery by applying machine learning (ML) algorithms on radiomic features extracted from pre-treatment magnetic resonance (MR) images. Methods: patients with VS treated with radiosurgery in two Centers from 2004 to 2016 were retrospectively evaluated. Brain [...] Read more.
Purpose: to predict vestibular schwannoma (VS) response to radiosurgery by applying machine learning (ML) algorithms on radiomic features extracted from pre-treatment magnetic resonance (MR) images. Methods: patients with VS treated with radiosurgery in two Centers from 2004 to 2016 were retrospectively evaluated. Brain T1-weighted contrast-enhanced MR images were acquired before and at 24 and 36 months after treatment. Clinical and treatment data were collected contextually. Treatment responses were assessed considering the VS volume variation based on pre- and post-radiosurgery MR images at both time points. Tumors were semi-automatically segmented and radiomic features were extracted. Four ML algorithms (Random Forest, Support Vector Machine, Neural Network, and extreme Gradient Boosting) were trained and tested for treatment response (i.e., increased or non-increased tumor volume) using nested cross-validation. For training, feature selection was performed using the Least Absolute Shrinkage and Selection Operator, and the selected features were used as input to separately build the four ML classification algorithms. To overcome class imbalance during training, Synthetic Minority Oversampling Technique was used. Finally, trained models were tested on the corresponding held out set of patients to evaluate balanced accuracy, sensitivity, and specificity. Results: 108 patients treated with Cyberknife® were retrieved; an increased tumor volume was observed at 24 months in 12 patients, and at 36 months in another group of 12 patients. The Neural Network was the best predictive algorithm for response at 24 (balanced accuracy 73% ± 18%, specificity 85% ± 12%, sensitivity 60% ± 42%) and 36 months (balanced accuracy 65% ± 12%, specificity 83% ± 9%, sensitivity 47% ± 27%). Conclusions: radiomics may predict VS response to radiosurgery avoiding long-term follow-up as well as unnecessary treatment. Full article
(This article belongs to the Special Issue Cancer Biomarkers and Therapy)
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12 pages, 265 KiB  
Study Protocol
Escalating a Biological Dose of Radiation in the Target Volume Applying Stereotactic Radiosurgery in Patients with Head and Neck Region Tumours
by Paweł Polanowski, Krzysztof Składowski, Dorota Księżniak-Baran, Aleksandra Grządziel, Natalia Amrogowicz, Jolanta Mrochem-Kwarciak, Agnieszka Pietruszka, Marek Kentnowski and Katarzyna Polanowska
Biomedicines 2022, 10(7), 1484; https://doi.org/10.3390/biomedicines10071484 - 23 Jun 2022
Viewed by 1826
Abstract
Background: The treatment of head and neck tumours is a complicated process usually involving surgery, radiation therapy, and systemic treatment. Despite the multidisciplinary approach, treatment outcomes are still unsatisfactory, especially considering malignant tumours such as squamous cell carcinoma or sarcoma, where the frequency [...] Read more.
Background: The treatment of head and neck tumours is a complicated process usually involving surgery, radiation therapy, and systemic treatment. Despite the multidisciplinary approach, treatment outcomes are still unsatisfactory, especially considering malignant tumours such as squamous cell carcinoma or sarcoma, where the frequency of recurrence has reached 50% of cases. The implementation of modern and precise methods of radiotherapy, such as a radiosurgery boost, may allow for the escalation of the biologically effective dose in the gross tumour volume and improve the results of treatment. Methods: The administration of a stereotactic radiotherapy boost can be done in two ways: an upfront boost followed by conventional radio(chemo)therapy or a direct boost after conventional radio(chemo)therapy. The boost dose depends on the primary or nodal tumour volume and localization regarding the organs at risk. It falls within the range of 10–18 Gy. Discussion: The collection of detailed data on the response of the disease to the radiosurgery boost combined with conventional radiotherapy as well as an assessment of early and late toxicities will contribute crucial information to the prospective modification of fractionated radiotherapy. In the case of beneficial findings, the stereotactic radiosurgery boost in the course of radio(chemo)therapy in patients with head and neck tumours will be able to replace traditional techniques of radiation, and radical schemes of treatment will be possible for future development. Full article
(This article belongs to the Special Issue State-of-the-Art Cancer Biology and Therapeutics in Poland)
38 pages, 235 KiB  
Review
Treatment of Brain Metastasis from Lung Cancer
by Alexander Chi and Ritsuko Komaki
Cancers 2010, 2(4), 2100-2137; https://doi.org/10.3390/cancers2042100 - 15 Dec 2010
Cited by 62 | Viewed by 15861
Abstract
Brain metastases are not only the most common intracranial neoplasm in adults but also very prevalent in patients with lung cancer. Patients have been grouped into different classes based on the presence of prognostic factors such as control of the primary tumor, functional [...] Read more.
Brain metastases are not only the most common intracranial neoplasm in adults but also very prevalent in patients with lung cancer. Patients have been grouped into different classes based on the presence of prognostic factors such as control of the primary tumor, functional performance status, age, and number of brain metastases. Patients with good prognosis may benefit from more aggressive treatment because of the potential for prolonged survival for some of them. In this review, we will comprehensively discuss the therapeutic options for treating brain metastases, which arise mostly from a lung cancer primary. In particular, we will focus on the patient selection for combined modality treatment of brain metastases, such as surgical resection or stereotactic radiosurgery (SRS) combined with whole brain irradiation; the use of radiosensitizers; and the neurocognitive deficits after whole brain irradiation with or without SRS. The benefit of prophylactic cranial irradiation (PCI) and its potentially associated neuro-toxicity for both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are also discussed, along with the combined treatment of intrathoracic primary disease and solitary brain metastasis. The roles of SRS to the surgical bed, fractionated stereotactic radiotherapy, WBRT with an integrated boost to the gross brain metastases, as well as combining WBRT with epidermal growth factor receptor (EGFR) inhibitors, are explored as well. Full article
(This article belongs to the Special Issue Organ-Specific Metastasis Formation)
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13 pages, 198 KiB  
Article
Management of Single Brain Metastasis: A Practice Guideline
by A. Mintz, J. Perry, K. Spithoff, A. Chambers, N. Laperriere and on behalf of the Neuro-oncology Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care
Curr. Oncol. 2007, 14(4), 131-143; https://doi.org/10.3747/co.2007.129 - 1 Aug 2007
Cited by 106 | Viewed by 2006
Abstract
Questions: Should patients with confirmed single brain metastasis undergo surgical resection? Should patients with single brain metastasis undergoing surgical resection receive adjuvant wholebrain radiation therapy (WBRT)? What is the role of stereotactic radiosurgery (SRS) in the management of [...] Read more.
Questions: Should patients with confirmed single brain metastasis undergo surgical resection? Should patients with single brain metastasis undergoing surgical resection receive adjuvant wholebrain radiation therapy (WBRT)? What is the role of stereotactic radiosurgery (SRS) in the management of patients with single brain metastasis? Perspectives: Approximately 15%–30% of patients with cancer will develop cerebral metastases over the course of their disease. Patients identified as having single brain metastasis generally undergo more aggressive treatment than do those with multiple metastases; however, in the province of Ontario, management of patients with single brain metastasis varies. Given that conflicting evidence has been reported, the Neuro-oncology Disease Site Group (DSG) of the Cancer Care Ontario Program in Evidence-based Care felt that a systematic review of the evidence and a practice guideline were warranted. Outcomes: Outcomes of interest were survival, local control of disease, quality of life, and adverse effects. Methodology: The MEDLINE, CANCERLIT, EMBASE, and Cochrane Library databases and abstracts published in the proceedings of the annual meetings of the American Society of Clinical Oncology (1997–2005) and American Society for Therapeutic Radiology and Oncology (1998–2004) were systematically searched for relevant evidence. The review included fully published reports or abstracts of randomized controlled trials (RCTS), nonrandomized prospective studies, and retrospective studies. The present systematic review and practice guideline has been reviewed and approved by the Neurooncology DSG, which comprises medical and radiation oncologists, surgeons, neurologists, a nurse, and a patient representative. External review by Ontario practitioners was obtained through an electronic survey. Final approval of the guideline report was obtained from the Report Approval Panel and the Neuro-oncology DSG. Results: Quality of Evidence The literature search found three RCTS that compared surgical resection plus WBRT with WBRT alone. In addition, a Cochrane review, including a meta-analysis of published data from those three RCTS, was obtained. One RCT compared surgical resection plus WBRT with surgical resection alone. One RCT compared WBRT plus SRS with WBRT alone. Evidence comparing SRS with surgical resection or examining SRS with or without WBRT was limited to prospective case series and retrospective studies. Benefits Two of three RCTS reported a significant survival benefit for patients who underwent surgical resection as compared with those who received WBRT alone. Pooled results of the three RCTS indicated no significant difference in survival or likelihood of dying from neurologic causes; however, significant heterogeneity was detected between the trials. The RCT that compared surgical resection plus WBRT with surgical resection alone reported no significant difference in overall survival or length of functional independence; however, tumour recurrence at the site of the metastasis and anywhere in the brain was less frequent in patients who received WBRT as compared with patients in the observation group. In addition, patients who received WBRT were less likely to die from neurologic causes. Results of the RCT that compared WBRT plus SRS with WBRT alone indicated a significant improvement in median survival in patients who received SRS. No quality evidence compares the efficacy of SRS with surgical resection or examines the question of whether patients who receive SRS should also receive WBRT . Harms Pooled results of the three RCTS that examined surgical resection indicated no significant difference in adverse effects between groups. Postoperative complications included respiratory problems, intracerebral hemorrhage, and infection. One RCT reported no significant difference in adverse effects between patients who received WBRT plus SRS and those who received WBRT alone. Practice Guideline: Target Population The recommendations that follow apply to adults with confirmed cancer and a single brain metastasis. This practice guideline does not apply to patients with metastatic lymphoma, small-cell lung cancer, germ-cell tumour, leukemia, or sarcoma. Recommendations Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis amenable to complete excision. Because treatment in cases of single brain metastasis is considered palliative, invasive local treatments must be individualized. Patients with lesions requiring emergency decompression because of intracranial hypertension were excluded from the RCTS, but should be considered candidates for surgery. To reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis, postoperative WBRT should be considered. The optimal dose and fractionation schedule for WBRT is 3000 cGy in 10 fractions or 2000 cGy in 5 fractions. As an alternative to surgical resection, WBRT followed by SRS boost should be considered for patients with single brain metastasis. The evidence is insufficient to recommend SRS alone as a single-modality therapy. Qualifying Statements No high-quality data are available regarding the choice of surgery versus radiosurgery for single brain metastasis. In general, the size and location of the metastasis determine the optimal approach. The standard WBRT regimen for management of patients with single brain metastasis in the United States is 3000 cGy in 10 fractions, and this treatment is usually the standard arm in randomized studies of radiation in patients with brain metastases. Based solely on evidence, the understanding that no reason exists to choose 3000 cGy in 10 fractions over 2000 cGy in 5 fractions is correct; however, fraction size is believed to be important, and therefore 300 cGy daily (3000/10) is believed to be associated with fewer long-term neurocognitive effects than 400 cGy daily (2000/5) in the occasional long-term survivor. For that reason, many radiation oncologists in Ontario prefer 3000 cGy in 10 fractions. No data exist to either support or refute that preference; therefore, finding a resolution to this issue is not currently possible. The Neuro-oncology DSG will update the recommendations as new evidence becomes available. Full article
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