Impact of MRI timing on tumor volume and anatomic displacement for brain metastases undergoing stereotactic radiosurgery

Tugce Kutuk; Ranjini Tolakanahalli; Andre Williams; Martin C Tom; Jason D Vadhan; Haley Appel; Matthew D Hall; D Jay J Wieczorek; Stephen Davis; Michael W McDermott; Manmeet S Ahluwalia; Minesh P Mehta; Alonso N Gutierrez; Rupesh Kotecha

doi:10.1093/nop/npab047

Impact of MRI timing on tumor volume and anatomic displacement for brain metastases undergoing stereotactic radiosurgery

Neurooncol Pract. 2021 Jul 28;8(6):674-683. doi: 10.1093/nop/npab047. eCollection 2021 Dec.

Authors

Tugce Kutuk¹, Ranjini Tolakanahalli^{1

2}, Andre Williams³, Martin C Tom^{1

2}, Jason D Vadhan¹, Haley Appel¹, Matthew D Hall^{1

2}, D Jay J Wieczorek^{1

2}, Stephen Davis^{1

2}, Michael W McDermott^{2

4}, Manmeet S Ahluwalia^{2

5}, Minesh P Mehta^{1

2}, Alonso N Gutierrez^{1

2}, Rupesh Kotecha^{1

2}

Affiliations

¹ Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.
² Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
³ Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.
⁴ Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida, USA.
⁵ Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.

Abstract

Background: The objective of this study was to evaluate the impact of the time interval between planning imaging and stereotactic radiosurgery (SRS) delivery on tumor volumes and spatial anatomic displacements of brain metastases (BM).

Methods: Consecutive patients diagnosed with BM treated with SRS over a 3-year period were evaluated. Only patients who underwent an institutionally standardized diagnostic MRI (MRI-1) and a treatment planning MRI (MRI-2) were included. The impact of histology, inter-scan time interval, lesion location, tumor volume, and diameter were evaluated on final lesion diameter, volume, anatomic displacement, and ultimate need for change in management (ie, expanding margins, rescanning).

Results: 101 patients (531 lesions) with a median inter-scan time interval of 8 days (range: 1-42 days) met the inclusion criteria. The median percentage increase in BM diameter and volume were 9.5% (IQR: 2.25%-24.0%) and 20% (IQR: 0.7%-66.7%). Overall, 147 lesions (27.7%) in 57 patients (56.4%) required a change in management. There was a statistically significant relationship between initial tumor diameter (cm) and change in management (OR: 2.69, 95% CI: 1.93-3.75; P < .001). Each day between MRI-1 and MRI-2 was associated with a change in management with an OR of 1.05 (95% CI: 1.03-1.07; P < .001).

Conclusions: Changes in tumor diameter, volume, and spatial position occur as a function of time. Planning imaging for SRS is recommended to occur in close temporal proximity to treatment; for those with delays, a larger setup margin may need to be used to ensure tumor coverage and account for positional changes.

Keywords: MRI timing; SRS; brain metastasis; radiosurgery; tumor dynamics.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.