Optimizing the radiation treatment planning of brain tumors by integration of Functional MRI and White Matter Tractography

Purpose: The purpose of this study was to assess whether the incorporation of functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) data into the radiation treatment planning process of brain tumors could spare the neurological parts of the brain from high doses of radiation. Methods: In this study, the fMRI and DTI data were obtained from eight glioma patients and included in the radiation treatment plan‏. This patient-specific fMRI and DTI data were attained based on tumor location, patient's general conditions, and the importance of the functional and fiber tract areas. The functional regions, fiber tracts, anatomical organs at risk, and the tumor were contoured for radiation treatment planning. Finally, the radiation treatment planning with and without fMRI & DTI information was obtained and compared. Results: On average, the mean dose to the functional areas was reduced by 25.36%, and the maximum dose was reduced by 18.57% on fMRI & DTI plans compared with the anatomical plans In addition, 15.59% and 20.84% reductions in the mean and maximum doses of the fiber tracts were achieved, respectively. Conclusion: This study demonstrated the feasibility of using fMRI and DTI data in radiation treatment planning to maximize radiation protection of the functional cortex and fiber tracts. We also observed a significant reduction in the mean and maximum doses to these neurologically relevant brain regions. Dose reduction would reduce the neuro-cognitive complications and improve the patient's quality of life .