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Purpose  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).    Methods and Materials  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 max ), doses covering certain volume (D V ) from 0.03 to 20 cc and absolute volumes receiving specific dose (V D ) from 40 to 80 Gy. Inter-structure variability was assessed by coefficients of variation (CV) and paired samples  t -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.    Results  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 V  in temporal lobe was significantly smaller than that in half-brain (P < 0.001), and the reduction ranged from 3.10% to 45.98%. The area under the curve (AUC) of D V  and V D  showed an “increase-maximum-decline” behavior with a peak as the volume or dose increased. The maximal AUCs of D V s in brain, half-brain and temporal lobe were 0.808 (D 2cc ), 0.828 (D 1.2cc ) and 0.806 (D 0.6cc ), respectively, and the maximal AUCs of V D s were 0.818 (D 75Gy ), 0.834 (V 72Gy ) and 0.814 (V 70Gy ), respectively. The cutoffs of V 70Gy  (0.86 cc), V 71Gy  (0.72 cc), V 72Gy  (0.60 cc), and V 73Gy  (0.45 cc) in half-brain had better Youden index. TD5/5 and TD50/5 of D 1.2cc  were 58.7 and 80.0 Gy, respectively. The probability of TLI was higher than >13% when V 72Gy >0 cc, and equal to 50% when V 72Gy  = 7.66 cc.    Conclusion  Half-brain delineation is a convenient and stable method which could reduce contouring variation and could be used in NPC patients. D 1.2cc  and V 72Gy  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 70–73Gy  could be considered when the high dose is inevitable.

Half-Brain Delineation for Prediction of Radiation-Induced Temporal Lobe Injury in Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiotherapy