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Fig. 3 | Radiation Oncology

Fig. 3

From: High incidence of radiation-induced brain necrosis in the periventricular deep white matter: stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy

Fig. 3

Patient (no. 2 in Table 2) of radiation brain necrosis (RBN) in deep white matter around the lateral ventricle. a) Dose distribution diagram of stereotactic irradiation with VMAT. b) GTV mar-ginal dose is matched to 36 Gy in 3 fractions (red line) and GTV + 3 mm PTV marginal dose to 27 Gy (light blue line). Tumor center is increased to 45 Gy (dark red line). b) Dose volume histogram shows the coverage of the GTV dose, the dose reduction in the GTV + 3 mm region and the increase in the tumor center dose. Gadolinium-enhanced T1-weighted axial MR images show deep white matter brain metastasis around the lateral ventricle c) before stereotactic irradiation with VMAT, d) complete response 12 months after the stereotactic irradiation and e) re-growth 18 months after the stereotactic irradiation. f) In 11 C-methionine-PET, 20 months after the stereotactic irradiation, the re-growth lesion is lower lesion-to-brain ratio of 1.37, which is diagnostic of radiation brain necrosis. g) Gadolinium-enhanced T1-weighted axial MR images shows increased radiation brain necrosis 24 months after the stereotactic irradiation

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Radiation Oncology

ISSN: 1748-717X

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