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Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the role of half-brain delineation in the prediction of radiation-induced temporal lobe injury (TLI) in nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Materials<\/jats:title><jats:p>A total of 220 NPC cases treated with IMRT and concurrent platinum-based chemotherapy were retrospectively analyzed. Dosimetric parameters of temporal lobes, half-brains, and brains included maximum dose (D<jats:sub>max<\/jats:sub>), doses covering certain volume (D<jats:sub>V<\/jats:sub>) from 0.03 to 20 cc and absolute volumes receiving specific dose (V<jats:sub>D<\/jats:sub>) from 40 to 80 Gy. Inter-structure variability was assessed by coefficients of variation (CV) and paired samples <jats:italic>t<\/jats:italic>-tests. Receiver operating characteristic curve (ROC) and Youden index were used for screening dosimetric parameters to predict TLI. Dose\/volume response curve was calculated using the logistic dose\/volume response model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CVs of brains, left\/right half-brains, and left\/right temporal lobes were 9.72%, 9.96%, 9.77%, 27.85%, and 28.34%, respectively. Each D<jats:sub>V<\/jats:sub> in temporal lobe was significantly smaller than that in half-brain (P &amp;lt; 0.001), and the reduction ranged from 3.10% to 45.98%. The area under the curve (AUC) of D<jats:sub>V<\/jats:sub> and V<jats:sub>D<\/jats:sub> showed an \u201cincrease-maximum-decline\u201d behavior with a peak as the volume or dose increased. The maximal AUCs of D<jats:sub>V<\/jats:sub>s in brain, half-brain and temporal lobe were 0.808 (D<jats:sub>2cc<\/jats:sub>), 0.828 (D<jats:sub>1.2cc<\/jats:sub>) and 0.806 (D<jats:sub>0.6cc<\/jats:sub>), respectively, and the maximal AUCs of V<jats:sub>D<\/jats:sub>s were 0.818 (D<jats:sub>75Gy<\/jats:sub>), 0.834 (V<jats:sub>72Gy<\/jats:sub>) and 0.814 (V<jats:sub>70Gy<\/jats:sub>), respectively. The cutoffs of V<jats:sub>70Gy<\/jats:sub> (0.86 cc), V<jats:sub>71Gy<\/jats:sub> (0.72 cc), V<jats:sub>72Gy<\/jats:sub> (0.60 cc), and V<jats:sub>73Gy<\/jats:sub> (0.45 cc) in half-brain had better Youden index. TD5\/5 and TD50\/5 of D<jats:sub>1.2cc<\/jats:sub> were 58.7 and 80.0 Gy, respectively. The probability of TLI was higher than &amp;gt;13% when V<jats:sub>72Gy<\/jats:sub>&amp;gt;0 cc, and equal to 50% when V<jats:sub>72Gy<\/jats:sub> = 7.66 cc.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Half-brain delineation is a convenient and stable method which could reduce contouring variation and could be used in NPC patients. D<jats:sub>1.2cc<\/jats:sub> and V<jats:sub>72Gy<\/jats:sub> of half-brain are feasible for TLI prediction model. The dose below 70 Gy may be relatively safe for half-brain. The cutoff points of V<jats:sub>70\u201373Gy<\/jats:sub> could be considered when the high dose is inevitable.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2021.599942","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T07:09:52Z","timestamp":1617260992000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Half-Brain Delineation for Prediction of Radiation-Induced Temporal Lobe Injury in Nasopharyngeal Carcinoma Receiving Intensity-Modulated 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