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. 2024 Nov 4;19(11):e0313199.
doi: 10.1371/journal.pone.0313199. eCollection 2024.

Radiosurgery-induced early changes in peritumoral tissue sodium concentration of brain metastases

Arne Mathias Ruder  1 , Sherif A Mohamed  2 , Michaela A U Hoesl  3 , Eva Neumaier-Probst  2 , Frank A Giordano  1 , Lothar Schad  3 , Anne Adlung  3
Affiliations

Radiosurgery-induced early changes in peritumoral tissue sodium concentration of brain metastases

Arne Mathias Ruder et al. PLoS One. .

Abstract

Background: Stereotactic radiosurgery (SRS) is an effective therapy for brain metastases. Response is assessed with serial 1H magnetic resonance imaging (MRI). Early markers for response are desirable to allow for individualized treatment adaption. Previous studies indicated that radiotherapy might have impact on tissue sodium concentration. Thus, 23Na MRI could provide early quantification of response to SRS.

Purpose: We investigated whether longitudinal detection of tissue sodium concentration alteration within brain metastases and their peritumoral tissue after SRS with 23Na MRI was feasible.

Study type: Prospective.

Population: Twelve patients with a total of 14 brain metastases from various primary tumors.

Assessment: 23Na MRI scans were acquired from patients 2 days before, 5 days after, and 40 days after SRS. Gross tumor volume (GTV) and healthy-appearing regions were manually segmented on the MPRAGE obtained 2 days before SRS, onto which all 23Na MR images were coregistered. Radiation isodose areas within the peritumoral tissue were calculated with the radiation planning system. Tissue sodium concentration before and after SRS within GTV, peritumoral tissue, and healthy-appearing regions as well as the routine follow-up with serial MRI were evaluated.

Statistical tests: Results were compared using Student's t-test and correlation was evaluated with Pearson's correlation coefficient.

Results: We found a positive correlation between the tissue sodium concentration within the peritumoral tissue and radiation dosage. Two patients showed local progression and a differing tissue sodium concentration evolution within GTV and the peritumoral tissue compared to mean tissue sodium concentration of the other patients. No significant tissue sodium concentration changes were observed within healthy-appearing regions.

Conclusion: Tissue sodium concentration assessment within brain metastases and peritumoral tissue after SRS with 23Na MRI is feasible and might be able to quantify tissue response to radiation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Co-registered MPRAGE and 23Na.
One representative transverse slice of one patient’s MPRAGE and the co-registered 23Na at all three measurements: scan (I) (t = SRS– 2 days), scan (II) (t = SRS + 5 days), and scan (III) (t = SRS + 40 days). The isodose areas and the two GTV are being visualized within the MPRAGE as color-coded regions.
Fig 2
Fig 2. Mean TSC within the GTV.
Boxplot of the mean TSC within the GTV (blue), and the HR (red) at all three measurements: scan (I) (t = SRS– 2 days), scan (II) (t = SRS + 5 days), and scan (III) (t = SRS + 40 days). The middle line in the box depicts the median value and the boxes’ top and bottom edges the 25th and 75th percentiles of the data, respectively. The whiskers extend to the most extreme data points not considering outliers which are depicted by “+”. The top figure depicts TSC evolution for stable brain metastases and the two bottom figures depict the TSC evolution of the two progressive brain metastases (left: soft tissue sarcoma, right: mammary carcinoma). (BM: brain metastases).
Fig 3
Fig 3. TSC of the peritumoral tissue.
Boxplot of the mean TSC of all stable brain metastases within the isodose areas D = 18 Gy (blue), D = 10 Gy (red) and D = 2 Gy (yellow) at all three measurements: scan (I) (t = SRS– 2 days), scan (II) (t = SRS + 5 days), and scan (III) (t = SRS + 40 days). The middle line in the box depicts the median value and the boxes’ top and bottom edges represent the 25th and 75th percentiles of the data, respectively. The whiskers extend to the most extreme data points.
Fig 4
Fig 4. TSC in the peritumoral tissue of stable and progressive brain metastases.
Plot of the mean TSC over the observed isodose areas at all three measurements: scan (I) in blue (t = SRS– 2 days), scan (II) in red (t = SRS + 5 days), and scan (III) in yellow (t = SRS + 40 days). The figure shows the TSC evolution separately for patients with stable brain metastases either from NSCLC or from any other primary. The bottom plot shows the TSC evolution of both patients with progressive brain metastases. Here, the patient with a BM from soft tissue sarcoma is depicted with triangles and the patient with a BM from mammary carcinoma is depicted with pentagrams. (BM: brain metastases).
See this image and copyright information in PMC

References

    1. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al.. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. The Lancet Oncology. 2009;10(11):1037–44. Epub 20091002. doi: 10.1016/S1470-2045(09)70263-3 . - DOI - PubMed
    1. Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, et al.. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. The Lancet Oncology. 2014;15(4):387–95. 10.1016/S1470-2045(14)70061-0. - DOI - PubMed
    1. Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, et al.. Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial. JAMA. 2016;316(4):401–9. Epub 2016/07/28. doi: 10.1001/jama.2016.9839 ; PubMed Central PMCID: PMC5313044. - DOI - PMC - PubMed
    1. Kelly PJ, Lin NU, Claus EB, Quant EC, Weiss SE, Alexander BM. Salvage stereotactic radiosurgery for breast cancer brain metastases. Cancer. 2012;118(8):2014–20. doi: 10.1002/cncr.26343 - DOI - PubMed
    1. Kurtz G, Zadeh G, Gingras-Hill G, Millar B-A, Laperriere NJ, Bernstein M, et al.. Salvage Radiosurgery for Brain Metastases: Prognostic Factors to Consider in Patient Selection. International Journal of Radiation Oncology*Biology*Physics. 2014;88(1):137–42. doi: 10.1016/j.ijrobp.2013.10.003 - DOI - PubMed