Prog Med Phys.  2024 Mar;35(1):1-9. 10.14316/pmp.2024.35.1.1.

Impact of Planning Target Volume Margins in Stereotactic Radiosurgery for Brain Metastasis: A Review

• Fiagbedzi E
• Hasford F
• Tagoe SN

• KMID: 2554466
• DOI: http://doi.org/10.14316/pmp.2024.35.1.1

Abstract

Margin inclusion or exclusion remains the most critical and controversial aspect of stereotactic radiosurgery (SRS) for metastatic brain tumors. This review aimed to examine the available literature on the impact of margins in SRS of brain metastasis and to assess the response of some medical physicists on the use of these margins. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used to review articles published in PubMed, Embase, and Science Direct databases from January 2012 to December 2022 using the following keywords: planning target volume, brain metastasis, margin, and stereotactic radiosurgery. A simple survey consisting of five questions was completed by ten medical physicists with experience in SRS treatment planning. The results were analyzed using IBM SPSS Statistics version 26.0. Of the 1,445 articles identified, only 38 articles were chosen. Of these, eight papers were deemed relevant to the focus of this review. These papers showed an increase in the risk of radionecrosis, whereas differences in local control were variable as the margin increased. In the survey, the response rate to whether or not to use margins in SRS, a critical question, was 50%. Margin addition increases the risk of radio necrosis. The local control rate varies among treatment modalities and cannot be generalized. From the survey, no consensus was reached regarding the use of these margins. This calls for further deliberations among professionals directly involved in SRS.

Keyword

Planning target volume; Stereotactic radiosurgery; Margins; Brain metastasis

Figure

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  Fig. 1 Summary of the PRISMA flow [25].

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  Fig. 2 Graphical response of respondents for four of the questions. CTV, clinical target volume; GTV, gross tumor volume; PTV, planning target volume; SRS, stereotactic radiosurgery.

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  Fig. 3 Bar graph distributions of respondents’ answers to the fifth question: what the maximum and optimal planning target volume (PTV) margin should be to be accepted and applied in stereotactic radiosurgery treatment?

Reference

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