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Impact of Tumour Cell Infiltration on Treatment Outcome in Gamma Knife Radiosurgery: A Modelling Study
Marta Lazzeroni1, Zohreh Khazraei Manesh2, Helena Sandström3
1Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden marta.lazzeroni@fysik.su.se.
Background:
High-grade gliomas with a widespread infiltration beyond the lesion detectable on diagnostic images are increasingly treated with Gamma Knife™ Radiosurgery (GKRS). The aim of this study was to assess the cell infiltration impact on the GKRS outcome for invasive gliomas.
Materials And Methods:
Tumor cell distribution was predicted using a novel algorithm whose computations are iterated until they reach an agreement with histopathology results. Treatment plans with different combinations of dose prescription (20 Gy at 50%-20% isodose) and targets [Gross Tumour Volume (GTV), zone 1 with 100%-60% of the GTV cell density and zone 2 with 60%-0% of the GTV cell density] were evaluated using standard conformity indexes (CI) and radiobiological parameters.
Results:
Considerable differences in terms of tumor control probability were found between plans having similar CI but different targets.
Conclusion:
To account for tumor cell infiltration outside the target is of key importance in GKRS and a radiobiological evaluation should accompany well-established CI.
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