{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T19:59:41Z","timestamp":1790539181496,"version":"4.1.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the feasibility and dosimetric index features of dose painting guided by perfusion heterogeneity for brain metastasis (BMs) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 50 patients with single BMs were selected for this study. CT and MR simulation images were obtained, including contrast-enhanced T1-weighted images (T1WI+C) and cerebral blood flow (CBF) maps from 3D-arterial spin labeling (ASL). The gross tumor volume (GTV) was determined by fusion of CT and T1WI+C images. Hypoperfused subvolumes (GTV<jats:sub>H<\/jats:sub>) with less than 25% of the maximum CBF value were defined as the dose escalation region. The planning target volume (PTV) and PTV<jats:sub>H<\/jats:sub> were calculated from GTV and GTV<jats:sub>H<\/jats:sub> respectively. The PTV<jats:sub>N<\/jats:sub> was obtained by subtracting PTV<jats:sub>H<\/jats:sub> from PTV, and conventional dose was given. Three kinds of radiotherapy plans were designed based on the CBF values. Plan 1 was defined as the conventional plan with an arbitrary prescription dose of 60 Gy for PTV. For dose painting, Plan 2 and Plan 3 escalated the prescription dose for PTV<jats:sub>H<\/jats:sub> to 72 Gy based on Plan 1, but Plan 3 removed the maximum dose constraint. Dosimetric indices were compared among the three plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean GTV volume was 34.5 (8.4-118.0) cm<jats:sup>3<\/jats:sup>, and mean GTV<jats:sub>H<\/jats:sub> volume was 17.0 (4.5-58.3) cm<jats:sup>3<\/jats:sup>, accounting for 49.3% of GTV. Both conventional plan and dose painting plans achieved 98% target coverage. The conformity index of PTV<jats:sub>H<\/jats:sub> were 0.44 (Plan1), 0.64 and 0.72 (Plan 2 and Plan 3, <jats:italic>P&amp;lt;<\/jats:italic>0.05). Compared to Plan 1, the D<jats:sub>2%<\/jats:sub>, D<jats:sub>98%<\/jats:sub> and D<jats:sub>mean<\/jats:sub> values of the PTV<jats:sub>H<\/jats:sub> escalated by 20.50%, 19.32%, and 19.60% in Plan 2 and by 24.88%, 17.22% and 19.22% in Plan 3 respectively (<jats:italic>P&amp;lt;<\/jats:italic>0.05). In the three plans, the index of achievement value for PTV<jats:sub>H<\/jats:sub> was between 1.01 and 1.03 (<jats:italic>P&amp;lt;<\/jats:italic>0.05). The dose increment rates of Plan 2 and Plan 3 for each organs at risk (OARs) was controlled at 2.19% - 5.61% compared with Plan 1. The doses received by OARs did not significantly differ among the three plans (<jats:italic>P &amp;gt;<\/jats:italic>0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>BMs are associated with significant heterogeneity, and effective escalation of the dose delivered to target subvolumes can be achieved with dose painting guided by 3D-ASL without extra doses to OARs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.828312","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T11:56:12Z","timestamp":1669895772000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A novel approach for dose painting radiotherapy of brain metastases guided by mr perfusion 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