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@ARTICLE{Acker:275223,
      author       = {G. Acker and M. Nachbar and N. Soffried and B. Bodnar and
                      A. Janas and K. Krantchev and G. Kalinauskaite and A. Kluge
                      and D. Shultz and A. Conti and D. Kaul$^*$ and D. Zips and
                      P. Vajkoczy and C. Senger},
      title        = {{W}hat if: {A} retrospective reconstruction of resection
                      cavity stereotactic radiosurgery to mimic neoadjuvant
                      stereotactic radiosurgery.},
      journal      = {Frontiers in oncology},
      volume       = {13},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2023-00681},
      pages        = {1056330},
      year         = {2023},
      abstract     = {Neoadjuvant stereotactic radiosurgery (NaSRS) of brain
                      metastases has gained importance, but it is not routinely
                      performed. While awaiting the results of prospective
                      studies, we aimed to analyze the changes in the volume of
                      brain metastases irradiated pre- and postoperatively and the
                      resulting dosimetric effects on normal brain tissue (NBT).We
                      identified patients treated with SRS at our institution to
                      compare hypothetical preoperative gross tumor and planning
                      target volumes (pre-GTV and pre-PTV) with original
                      postoperative resection cavity volumes (post-GTV and
                      post-PTV) as well as with a standardized-hypothetical PTV
                      with 2.0 mm margin. We used Pearson correlation to assess
                      the association between the GTV and PTV changes with the
                      pre-GTV. A multiple linear regression analysis was
                      established to predict the GTV change. Hypothetical planning
                      for the selected cases was created to assess the volume
                      effect on the NBT exposure. We performed a literature review
                      on NaSRS and searched for ongoing prospective trials.We
                      included 30 patients in the analysis. The pre-/post-GTV and
                      pre-/post-PTV did not differ significantly. We observed a
                      negative correlation between pre-GTV and GTV-change, which
                      was also a predictor of volume change in the regression
                      analysis, in terms of a larger volume change for a smaller
                      pre-GTV. In total, $62.5\%$ of cases with an enlargement
                      greater than 5.0 cm3 were smaller tumors (pre-GTV < 15.0
                      cm3), whereas larger tumors greater than 25.0 cm3 showed
                      only a decrease in post-GTV. Hypothetical planning for the
                      selected cases to evaluate the volume effect resulted in a
                      median NBT exposure of only $67.6\%$ (range: $33.2-84.5\%)$
                      relative to the dose received by the NBT in the
                      postoperative SRS setting. Nine published studies and twenty
                      ongoing studies are listed as an overview.Patients with
                      smaller brain metastases may have a higher risk of volume
                      increase when irradiated postoperatively. Target volume
                      delineation is of great importance because the PTV directly
                      affects the exposure of NBT, but it is a challenge when
                      contouring resection cavities. Further studies should
                      identify patients at risk of relevant volume increase to be
                      preferably treated with NaSRS in routine practice. Ongoing
                      clinical trials will evaluate additional benefits of NaSRS.},
      keywords     = {CyberKnife® (Other) / brain metastases (BM) (Other) /
                      neoadjuvant (Other) / preoperative (Other) / stereotactic
                      radiosurgery (SRS) (Other)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37007157},
      pmc          = {pmc:PMC10062706},
      doi          = {10.3389/fonc.2023.1056330},
      url          = {https://inrepo02.dkfz.de/record/275223},
}