title: The integral biologically effective dose to predict brain stem toxicity of hypofractionated stereotactic radiotherapy.
abstract: OBJECTIVE
  The aim of this work was to develop a parameter for use during fractionated stereotactic radiotherapy treatment planning to aid in the determination of the appropriate treatment volume and fractionation regimen that will minimize risk of late damage to normal tissue.
  
  
  METHODS
  We have used the linear quadratic model to assess the biologically effective dose at the periphery of stereotactic radiotherapy treatment volumes that impinge on the brain stem. This paper reports a retrospective study of 77 patients with malignant and benign intracranial lesions, treated between 1987 and 1995, with the dynamic rotation technique in 6 fractions over a period of 2 weeks, to a total dose of 42 Gy prescribed at the 90% isodose surface. From differential dose-volume histograms, we evaluated biologically effective dose-volume histograms and obtained an integral biologically-effective dose (IBED) in each case.
  
  
  RESULTS
  Of the 77 patients in the study, 36 had target volumes positioned so that the brain stem received more than 1% of the prescribed dose, and 4 of these, all treated for meningioma, developed serious late damage involving the brain stem. Other than type of lesion, the only significant variable was the volume of brain stem exposed. An analysis of the IBEDs received by these 36 patients shows evidence of a threshold value for late damage to the brain stem consistent with similar thresholds that have been determined for external beam radiotherapy.
  
  
  CONCLUSIONS
  We have introduced a new parameter, the IBED, that may be used to represent the fractional effective dose to structures such as the brain stem that are partially irradiated with stereotactic dose distributions. The IBED is easily calculated prior to treatment and may be used to determine appropriate treatment volumes and fractionation regimens minimizing possible toxicity to normal tissue.
authors.affiliation: Department of Oncology, McGill University, Montréal, Canada. bclark@bccancer.bc.ca
authors.forename: B G
authors.initials: BG
authors.lastname: Clark
authors.forename: L
authors.initials: L
authors.lastname: Souhami
authors.forename: C
authors.initials: C
authors.lastname: Pla
authors.forename: A S
authors.initials: AS
authors.lastname: Al-Amro
authors.forename: J P
authors.initials: JP
authors.lastname: Bahary
authors.forename: J G
authors.initials: JG
authors.lastname: Villemure
authors.forename: J L
authors.initials: JL
authors.lastname: Caron
authors.forename: A
authors.initials: A
authors.lastname: Olivier
authors.forename: E B
authors.initials: EB
authors.lastname: Podgorsak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000528:radiation effects*; D002648:Child; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D016634:Radiosurgery; D012062:Relative Biological Effectiveness; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed