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Diehl, C. ; Rosenkranz, E.* ; Schwendner, M.J.* ; Mißlbeck, M.* ; Sollmann, N.* ; Ille, S.* ; Meyer, B.* ; Combs, S.E. ; Krieg, S.M.*

Dose reduction to motor structures in adjuvant fractionated stereotactic radiotherapy of brain metastases: nTMS-derived DTI-based motor fiber tracking in treatment planning.

Cancers 15:282 (2023)

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BACKGROUND: Resection of brain metastases (BM) close to motor structures is challenging for treatment. Navigated transcranial magnetic stimulation (nTMS) motor mapping, combined with diffusion tensor imaging (DTI)-based fiber tracking (DTI-FT_mot.TMS), is a valuable tool in neurosurgery to preserve motor function. This study aimed to assess the practicability of DTI-FT_mot.TMS for local adjuvant radiotherapy (RT) planning of BM. METHODS: Presurgically generated DTI-FT_mot.TMS-based corticospinal tract (CST) reconstructions (FT_mot.TMS) of 24 patients with 25 BM resected during later surgery were incorporated into the RT planning system. Completed fractionated stereotactic intensity-modulated RT (IMRT) plans were retrospectively analyzed and adapted to preserve FT_mot.TMS. RESULTS: In regular plans, mean dose (D_mean) of complete FT_mot.TMS was 5.2 ± 2.4 Gy. Regarding planning risk volume (PRV-FT_TMS) portions outside of the planning target volume (PTV) within the 17.5 Gy (50%) isodose line, the DTI-FT_mot.TMS D_mean was significantly reduced by 33.0% (range, 5.9-57.6%) from 23.4 ± 3.3 Gy to 15.9 ± 4.7 Gy (p < 0.001). There was no significant decline in the effective treatment dose, with PTV D_mean 35.6 ± 0.9 Gy vs. 36.0 ± 1.2 Gy (p = 0.063) after adaption. CONCLUSIONS: The DTI-FT_mot.TMS-based CST reconstructions could be implemented in adjuvant IMRT planning of BM. A significant dose reduction regarding motor structures within critical dose levels seems possible.

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