title: Prognostic Value of MR Imaging Texture Analysis in Brain Non-Small Cell Lung Cancer Oligo-Metastases Undergoing Stereotactic Irradiation.
abstract: BACKGROUND : Stereotactic irradiation is widely used in brain oligo-metastases treatment. The aim of this study is to evaluate the prognostic value of magnetic resonance imaging (MRI) texture analysis (TA) of brain metastases (BM) of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS : This study included thirty-eight consecutive patients undergoing stereotactic irradiation, that is, stereotactic fractionated radiotherapy (SRT) or radiosurgery (SRS), from January 2011 to December 2014 for 1-2 brain BM from NSCLC. Whole-brain radiotherapy (WBRT) was not delivered. The diagnostic MRI DICOM (Digital Imaging and Communications in Medicine) images were collected and analyzed with a homemade ImageJ macro, and typical TA parameters (mean, standard deviation, skewness, kurtosis, entropy, and uniformity) were evaluated for: brain progression-free survival; modality of brain metastatic progression (local progression or/and new metastases); and overall survival, after SRT/SRS.
  
  
  RESULTS
  After SRT/SRS 14 patients (36.8%) experienced recurrence in the brain, with a recurrence in the irradiated site (five patients, 13.2%), new metastases (11 patients, 28.9%), local recurrence and new metastases (two patients, 5.25%). Nineteen patients (50%) died of tumor progression or other causes. Entropy and uniformity were significantly associated with local progression, whereas kurtosis was significantly associated with both local progression and new brain metastases. CONCLUSIONS : These results appear promising, since the knowledge of factors correlated with the modality of brain progression after stereotactic irradiation of brain oligo-metastatic foci of NSCLC might help in driving the best treatment in these patients (association of SRT/SRS with WBRT? Increase of SRT/SRS dose?). Our preliminary data needs confirmation in large patient series.
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Nardone
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tini
authors.affiliation: Department of Medical Physics, University Hospital of Siena, Siena, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Biondi
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Sebaste
authors.affiliation: Department of Medical Physics, University Hospital of Siena, Siena, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Vanzi
authors.affiliation: Department of Medical Physics, University Hospital of Siena, Siena, Italy.
authors.forename: Gianmarco
authors.initials: G
authors.lastname: De Otto
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rubino
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Carfagno
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Battaglia
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Pastina
authors.affiliation: Unit of Neuro Radiology, University Hospital of Siena, Siena, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cerase
authors.affiliation: Department of Medical Physics, University Hospital of Siena, Siena, Italy.
authors.forename: Lorenzo Nicola
authors.initials: LN
authors.lastname: Mazzoni
authors.affiliation: Department of Medical Physics, University Hospital of Siena, Siena, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Banci Buonamici
authors.affiliation: Unit of Radiation Oncology, University Hospital of Siena, Siena, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pirtoli
keywords: brain metastases; non single cells lung cancer; srs; stereotactic irradiation; texture analysis