Dose–volume histogram analysis of brainstem necrosis in head and neck tumors treated using carbon-ion radiotherapy

Katsuyuki Shirai, Kyohei Fukata, Akiko Adachi, Jun ichi Saitoh, Atsushi Musha, Takanori Abe, Tatsuaki Kanai, Daijiro Kobayashi, Yuka Shigeta, Satoshi Yokoo, Kazuaki Chikamatsu, Tatsuya Ohno, Takashi Nakano

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Background and purpose: We aimed to evaluate the relationship between brainstem necrosis and dose–volume histograms in patients with head and neck tumors after carbon-ion radiotherapy. Material and methods: We evaluated 85 patients with head and neck tumors who underwent carbon-ion radiotherapy and were followed-up for ≥12 months. Brainstem necrosis was evaluated using the Common Terminology Criteria for Adverse Events (version 4.0). Results: The median follow-up was 24 months, and four patients developed grade 1 brainstem necrosis, with 2-year and 3-year cumulative rates of 2.8% and 6.5%, respectively. Receiver operating characteristic curve analysis revealed the following significant cut-off values: a maximum brainstem dose of 48 Gy (relative biological effectiveness [RBE]), D1 cm3 of 27 Gy (RBE), V40 Gy (RBE) of 0.1 cm3, V30 Gy (RBE) of 0.7 cm3, and V20 Gy (RBE) of 1.4 cm3. Multivariate analysis revealed that V30 Gy (RBE) was most significantly associated with brainstem necrosis. The 2-year cumulative rates were 33% and 0% for V30 Gy (RBE) of ≥0.7 cm3 and <0.7 cm3, respectively (p < 0.001). Conclusions: The present study indicated that the dose constraints might help minimize brainstem necrosis after carbon-ion radiotherapy.

Original languageEnglish
Pages (from-to)36-40
Number of pages5
JournalRadiotherapy and Oncology
Issue number1
Publication statusPublished - 2017 Oct
Externally publishedYes


  • Brainstem necrosis
  • Carbon-ion radiotherapy
  • Dose–volume histogram
  • Head and neck tumors
  • Non-squamous cell carcinoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging


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