Optimal α/β Ratio for Biologically Effective Dose-Based Prediction of Radiation-Induced Peritumoral Brain Edema in Meningioma

<b>Background</b>: Peritumoral brain edema (PTBE) is the most frequent complication for intracranial meningiomas following radiotherapy, yet no clinically validated biologically effective dose (BED) threshold capable of reliably predicting PTBE has currently been established. Although conventional radiobiological models typically assume an α/β ratio of 2-4 for benign meningiomas, whether these values accurately reflect the dose-response characteristics underlying radiation-induced PTBE remains unclear. <b>Methods</b>: We analyzed 67 intact meningiomas in the convexity, parasagittal, or falcine regions treated with primary linear accelerator (LINAC)-based radiotherapy. The BED values were recalculated using α/β ratios ranging from 2 to 20, and receiver operating characteristic (ROC) analyses were performed to identify the optimal BED thresholds for predicting PTBE. The most informative α/β ratio was defined as the value yielding the highest Youden's J statistic. <b>Results</b>: The ROC analyses showed that an assumed α/β ratio of 14 provided the highest discriminative accuracy for predicting PTBE in the overall cohort and markedly superior performance in patients younger than 70 years (area under the curve (AUC) 0.945; Youden's J = 0.871). The optimal BED threshold for predicting PTBE was approximately 41 Gy (α/β = 14), corresponding to ~18 Gy in a single fraction and ~5.8 Gy per fraction in a five-fraction regimen. <b>Conclusions</b>: The BED values calculated using α/β ratios near 14 provide the most reliable estimate of PTBE risk following primary LINAC-based radiotherapy for convexity, parasagittal, and falcine meningiomas. Maintaining prescription doses below this threshold may help reduce the likelihood of PTBE in this patient population.