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Tohidinezhad F, Zegers CML, Vaassen F, Dijkstra J, Anten M, Van Elmpt W, De Ruysscher D, Dekker A, Eekers DBP, Traverso A. Predicting the risk of neurocognitive decline after brain irradiation in adult patients with a primary brain tumor. Neuro Oncol 2024; 26:1467-1478. [PMID: 38595122 PMCID: PMC11300005 DOI: 10.1093/neuonc/noae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Deterioration of neurocognitive function in adult patients with a primary brain tumor is the most concerning side effect of radiotherapy. This study aimed to develop and evaluate normal-tissue complication probability (NTCP) models using clinical and dose-volume measures for 6-month, 1-year, and 2-year Neurocognitive Decline (ND) postradiotherapy. METHODS A total of 219 patients with a primary brain tumor treated with radical photon and/or proton radiotherapy (RT) between 2019 and 2022 were included. Controlled oral word association test, Hopkins verbal learning test-revised, and trail making test were used to objectively measure ND. A comprehensive set of potential clinical and dose-volume measures on several brain structures were considered for statistical modeling. Clinical, dose-volume and combined models were constructed and internally tested in terms of discrimination (area under the curve, AUC), calibration (mean absolute error, MAE), and net benefit. RESULTS Fifty percent, 44.5%, and 42.7% of the patients developed ND at 6-month, 1-year, and 2-year time points, respectively. The following predictors were included in the combined model for 6-month ND: age at radiotherapy > 56 years (OR = 5.71), overweight (OR = 0.49), obesity (OR = 0.35), chemotherapy (OR = 2.23), brain V20 Gy ≥ 20% (OR = 3.53), brainstem volume ≥ 26 cc (OR = 0.39), and hypothalamus volume ≥ 0.5 cc (OR = 0.4). Decision curve analysis showed that the combined models had the highest net benefits at 6-month (AUC = 0.79, MAE = 0.021), 1-year (AUC = 0.72, MAE = 0.027), and 2-year (AUC = 0.69, MAE = 0.038) time points. CONCLUSIONS The proposed NTCP models use easy-to-obtain predictors to identify patients at high risk of ND after brain RT. These models can potentially provide a base for RT-related decisions and post-therapy neurocognitive rehabilitation interventions.
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Affiliation(s)
- Fariba Tohidinezhad
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Femke Vaassen
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeanette Dijkstra
- Department of Medical Psychology, School for Mental Health and Neurosciences (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Monique Anten
- Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wouter Van Elmpt
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
- School of Medicine, Libera Università Vita-Salute San Raffaele, Milan, Italy
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2
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Tensaouti F, Courbière N, Cabarrou B, Pollidoro L, Roques M, Sévely A, Péran P, Baudou E, Laprie A. Metabolic Profile of Cerebellum in Posterior Fossa Tumor Survivors: Correlation With Memory Impairment. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00292-9. [PMID: 39107208 DOI: 10.1016/j.clon.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/16/2024] [Accepted: 07/18/2024] [Indexed: 08/09/2024]
Abstract
AIMS The cerebellum is a key structure in working and procedural memory. The aim of the present prospective exploratory study was to investigate, the metabolic characteristics of the cerebellum in posterior fossa tumor (PFT) survivors using 3D proton magnetic resonance spectroscopy imaging (3D MRSI), to determine whether metabolites could be useful biomarkers of memory impairment. MATERIALS AND METHODS Sixty participants were included in the IMPALA study, divided into three groups: 22 irradiated PFT, 17 nonirradiated PFT, and 21 healthy controls matched with irradiated PFT for age, sex, and handedness. PFT survivors were treated at least 5 years ago, either by surgery or a combination of surgery, chemotherapy, and radiotherapy. All participants underwent working and procedural memory tests and multimodal MRI including a 3D MRSI sequence. N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and lactate (Lac) metabolite values were extracted from the cerebellum for comparisons between groups, correlations with neurocognitive test scores, and radiotherapy doses. RESULTS Median (range) age at neurocognitive tests was 18 (7-26) years. Median Cho, Cr, NAA, and Lac values, and the ratio of NAA to the sum of metabolites were significantly lower for PFT survivors than for healthy controls (p < 0.05). Scores on working and procedural memory tests were significantly lower for PFT survivors (p < 0.004) and correlated with median and maximum Cho and NAA values (0.28 CONCLUSION Results revealed changes in cerebellar metabolic values in PFT survivors that were closely correlated with memory deficits, suggesting that some metabolites could be used as markers of cognitive decline, but this will require validation on a larger sample size.
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Affiliation(s)
- F Tensaouti
- Radiation Oncology Department, Oncopole Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France.
| | - N Courbière
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - B Cabarrou
- Biostatistics & Health Data Science Unit, Oncopole Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
| | - L Pollidoro
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - M Roques
- Radiology Department, Toulouse University Hospital, Toulouse, France
| | - A Sévely
- Radiology Department, Toulouse University Hospital, Toulouse, France
| | - P Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - E Baudou
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Pediatric Neurology Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - A Laprie
- Radiation Oncology Department, Oncopole Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
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3
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Mahajan A, Stavinoha PL, Rongthong W, Brodin NP, McGovern SL, El Naqa I, Palmer JD, Vennarini S, Indelicato DJ, Aridgides P, Bowers DC, Kremer L, Ronckers C, Constine L, Avanzo M. Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:401-416. [PMID: 33810950 DOI: 10.1016/j.ijrobp.2020.11.073] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A PENTEC review of childhood cancer survivors who received brain radiation therapy (RT) was performed to develop models that aid in developing dose constraints for RT-associated central nervous system (CNS) morbidities. METHODS AND MATERIALS A comprehensive literature search, through the PENTEC initiative, was performed to identify published data pertaining to 6 specific CNS toxicities in children treated with brain RT. Treatment and outcome data on survivors were extracted and used to generate normal tissue complication probability (NTCP) models. RESULTS The search identified investigations pertaining to 2 of the 6 predefined CNS outcomes: neurocognition and brain necrosis. For neurocognition, models for 2 post-RT outcomes were developed to (1) calculate the risk for a below-average intelligence quotient (IQ) (IQ <85) and (2) estimate the expected IQ value. The models suggest that there is a 5% risk of a subsequent IQ <85 when 10%, 20%, 50%, or 100% of the brain is irradiated to 35.7, 29.1, 22.2, or 18.1 Gy, respectively (all at 2 Gy/fraction and without methotrexate). Methotrexate (MTX) increased the risk for an IQ <85 similar to a generalized uniform brain dose of 5.9 Gy. The model for predicting expected IQ also includes the effect of dose, age, and MTX. Each of these factors has an independent, but probably cumulative effect on IQ. The necrosis model estimates a 5% risk of necrosis for children after 59.8 Gy or 63.6 Gy (2 Gy/fraction) to any part of the brain if delivered as primary RT or reirradiation, respectively. CONCLUSIONS This PENTEC comprehensive review establishes objective relationships between patient age, RT dose, RT volume, and MTX to subsequent risks of neurocognitive injury and necrosis. A lack of consistent RT data and outcome reporting in the published literature hindered investigation of the other predefined CNS morbidity endpoints.
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Affiliation(s)
- Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Peter L Stavinoha
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Warissara Rongthong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Joshua D Palmer
- Department of Radiation Oncology, James Cancer Hospital at Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Sabina Vennarini
- Proton Therapy Center, Azienda Provinciale per I Servizi Sanitari, Trento, Italy
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel C Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Leontien Kremer
- Department of Pediatrics, UMC Amsterdam, Location AMC, Amsterdam, the Netherlands; Department of Pediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Cecile Ronckers
- Department of Pediatrics, UMC Amsterdam, Location AMC, Amsterdam, the Netherlands; Department of Pediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Institute of Biostatistics and Registry Research, Medical University Brandenburg-Theodor Fontane, Neuruppin, Germany
| | - Louis Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Svaldi C, Ntemou E, Jonkers R, Kohnen S, de Aguiar V. Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: A systematic review. Eur J Paediatr Neurol 2024; 48:129-141. [PMID: 38377646 DOI: 10.1016/j.ejpn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Children who underwent posterior fossa tumor removal may have spoken or written language impairments. The present systematic review synthesized the literature regarding the language outcomes in this population. Benefits of this work were the identification of shortcomings in the literature and a starting point toward formulating guidelines for postoperative language assessment. METHODS A systematic literature search was conducted, identifying studies with patients who had posterior fossa surgery before 18 years of age. Included studies were narratively synthesized to understand language outcomes by language function (e.g., phonology, morphosyntax) at a group and individual level. Furthermore, the influence of several mediators (e.g., postoperative cerebellar mutism syndrome (pCMS), tumor type) was investigated. A critical evaluation of the language assessment tools was conducted. RESULTS The narrative synthesis of 66 studies showed that a broad spectrum of language impairments has been described, characterized by a large interindividual heterogeneity. Patients younger at diagnosis, receiving treatment for a high-grade tumor and/or radiotherapy and diagnosed with pCMS seemed more prone to impairment. Several gaps in language assessment remain, such as a baseline preoperative assessment and the assessment of pragmatics and morphosyntax. Further, there were important methodological differences in existing studies which complicated our ability to accurately guide clinical practice. CONCLUSION Children who had posterior fossa surgery seem to be at risk for postoperative language impairment. These results stress the need for language follow-up in posterior fossa tumor survivors.
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Affiliation(s)
- Cheyenne Svaldi
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands.
| | - Effy Ntemou
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands; International Doctorate for Experimental Approaches to Language and Brain (IDEALAB); Newcastle University, Newcastle upon Tyne, United Kingdom; Macquarie University, Sydney, Australia; University of Potsdam, Potsdam, Germany; University of Groningen, Groningen, the Netherlands; Linguistics Department, University of Potsdam, Haus 14, Karl-Liebknecht-Strasse 24-25, 14476, Potsdam, Germany.
| | - Roel Jonkers
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
| | - Saskia Kohnen
- School of Psychological Sciences, Macquarie University, University Avenue, NSW, 2109, Australia.
| | - Vânia de Aguiar
- Center for Language and Cognition, University of Groningen, PO box 716, 9700 AS, Groningen, the Netherlands.
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Salans M, Karunamuni R, Unnikrishnan S, Qian A, Connor M, Gudipati S, Yip A, Huynh-Le MP, Tibbs M, Reyes A, Stasenko A, Schadler A, McDonald C, Hattangadi-Gluth JA. Microstructural Cerebellar Injury Independently Associated With Processing Speed in Adult Patients With Primary Brain Tumors: Implications for Cognitive Preservation. Int J Radiat Oncol Biol Phys 2023; 117:1107-1117. [PMID: 37414262 DOI: 10.1016/j.ijrobp.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/08/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The cerebellum's role in posttreatment neurocognitive decline is unexplored. This study investigated associations between cerebellar microstructural integrity using quantitative neuroimaging biomarkers and neurocognition among patients with primary brain tumors receiving partial-brain radiation therapy (RT). METHODS AND MATERIALS In a prospective trial, 65 patients underwent volumetric brain magnetic resonance imaging, diffusion tensor imaging, and memory, executive function, language, attention, and processing speed (PS) assessment before RT and at 3, 6, and 12 months after RT. Delis-Kaplan Executive Function System-Trail Making (D-KEFS-TM) visual scanning and number and letter sequencing and Wechsler Adult Intelligence Scale, Fourth Edition, coding were used to evaluate PS. The cerebellar cortex and white matter (WM) and supratentorial structures subserving the previously mentioned cognitive domains were autosegmented. Volume was measured within each structure at each time point along with diffusion biomarkers (fractional anisotropy and mean diffusivity) in WM structures. Linear mixed-effects models assessed cerebellar biomarkers as predictors of neurocognitive scores. If associated, cerebellar biomarkers were evaluated as independent predictors of cognitive scores controlling for domain-specific supratentorial biomarkers. RESULTS Left (P = .04) and right (P < .001) cerebellar WM volume declined significantly over time. Cerebellar biomarkers were not associated with memory, executive function, or language. Smaller left cerebellar cortex volume was associated with worse D-KEFS-TM number (P = .01) and letter (P = .01) sequencing scores. A smaller right cerebellar cortex volume correlated with worse D-KEFS-TM visual scanning (P = .02) and number (P = .03) and letter (P = .02) sequencing scores. Greater right cerebellar WM mean diffusivity, indicating WM injury, was associated with worse D-KEFS-TM visual scanning performance (P = .03). Associations remained significant after controlling for corpus callosum and intrahemispheric WM injury biomarkers. CONCLUSIONS Injury to the cerebellum as measured with quantitative biomarkers correlates with worse post-RT PS, independent of corpus callosum and intrahemispheric WM damage. Efforts to preserve cerebellar integrity may preserve PS.
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Affiliation(s)
- Mia Salans
- Department of Radiation Oncology, University of California, San Francisco, California; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Soumya Unnikrishnan
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Alexander Qian
- Department of Radiation Oncology, University of California, San Francisco, California; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Michael Connor
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Suma Gudipati
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Anthony Yip
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | | | - Michelle Tibbs
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California
| | - Anny Reyes
- Department of Psychiatry, University of California, San Diego, California
| | - Alena Stasenko
- Department of Psychiatry, University of California, San Diego, California
| | - Adam Schadler
- Department of Psychiatry, University of California, San Diego, California
| | - Carrie McDonald
- Department of Psychiatry, University of California, San Diego, California
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California.
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6
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Sleurs C, Fletcher P, Mallucci C, Avula S, Ajithkumar T. Neurocognitive Dysfunction After Treatment for Pediatric Brain Tumors: Subtype-Specific Findings and Proposal for Brain Network-Informed Evaluations. Neurosci Bull 2023; 39:1873-1886. [PMID: 37615933 PMCID: PMC10661593 DOI: 10.1007/s12264-023-01096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/05/2023] [Indexed: 08/25/2023] Open
Abstract
The increasing number of long-term survivors of pediatric brain tumors requires us to incorporate the most recent knowledge derived from cognitive neuroscience into their oncological treatment. As the lesion itself, as well as each treatment, can cause specific neural damage, the long-term neurocognitive outcomes are highly complex and challenging to assess. The number of neurocognitive studies in this population grows exponentially worldwide, motivating modern neuroscience to provide guidance in follow-up before, during and after treatment. In this review, we provide an overview of structural and functional brain connectomes and their role in the neuropsychological outcomes of specific brain tumor types. Based on this information, we propose a theoretical neuroscientific framework to apply appropriate neuropsychological and imaging follow-up for future clinical care and rehabilitation trials.
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Affiliation(s)
- Charlotte Sleurs
- Department of Cognitive Neuropsychology, Tilburg University, 5037 AB, Tilburg, The Netherlands.
- Department of Oncology, KU Leuven, 3000, Leuven, Belgium.
| | - Paul Fletcher
- Department of Psychiatry, University of Cambridge, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, L14 5AB, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, L14 5AB, UK
| | - Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospital NHS Trust, Cambridge, CB2 0QQ, UK
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7
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Iyizoba-Ebozue Z, Prestwich R, Brown S, Hall E, Lilley J, Lowe M, Thomson DJ, Slevin F, Boele F, Murray L. Neurocognitive function following (chemo)radiotherapy for nasopharyngeal cancer and other head and neck cancers: A systematic review. Radiother Oncol 2023; 188:109863. [PMID: 37619657 DOI: 10.1016/j.radonc.2023.109863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
When radiotherapy is used in the treatment of head and neck cancers, the brain commonly receives incidental doses of radiotherapy with potential for neurocognitive changes and subsequent impact on quality of life. This has not been widely investigated to date. A systematic search of MEDLINE, EMBASE, Psycinfo Info and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases was conducted. Of 2077 records screened, 20 were eligible comprising 1308 patients. There were no randomised studies and 73.3% of included patients were from single center studies. IMRT was delivered in 72.6% of patients, and chemotherapy used in 61%. There was considerable heterogeneity in methods. Narrative synthesis was therefore carried out. Most studies demonstrated inferior neurocognitive outcomes when compared to control groups at 12 months and beyond radiotherapy. Commonly affected neurocognitive domains were memory and language which appeared related to radiation dose to hippocampus, temporal lobe, and cerebellum. Magnetic Resonance Imaging could be valuable in the detection of early microstructural and functional changes, which could be indicative of future neurocognitive changes. In studies investigating quality of life, the presence of neurocognitive impairment was associated with inferior quality of life outcomes. (Chemo)radiotherapy for head and neck cancer appears to be associated with a risk of long-term neurocognitive impairment. Few studies were identified, with substantial variation in methodology, thus limiting conclusions. High quality large prospective head and neck cancer studies using standardised, sensitive, and reliable neurocognitive tests are needed.
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Affiliation(s)
| | - Robin Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - John Lilley
- Department of Radiotherapy Physics, Leeds Cancer Centre, Leeds, UK
| | - Matthew Lowe
- Department of Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Finbar Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Louise Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
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8
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Hoeltgen L, Tessonnier T, Meixner E, Hoegen P, Kim JY, Deng M, Seidensaal K, Held T, Herfarth K, Debus J, Harrabi S. Proton Therapy for Advanced Juvenile Nasopharyngeal Angiofibroma. Cancers (Basel) 2023; 15:5022. [PMID: 37894389 PMCID: PMC10605854 DOI: 10.3390/cancers15205022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE To provide the first report on proton radiotherapy (PRT) in the management of advanced nasopharyngeal angiofibroma (JNA) and evaluate potential benefits compared to conformal photon therapy (XRT). METHODS We retrospectively reviewed 10 consecutive patients undergoing PRT for advanced JNA in a definitive or postoperative setting with a relative biological effectiveness weighted dose of 45 Gy in 25 fractions between 2012 and 2022 at the Heidelberg Ion Beam Therapy Center. Furthermore, dosimetric comparisons and risk estimations for short- and long-term radiation-induced complications between PRT plans and helical XRT plans were conducted. RESULTS PRT was well tolerated, with only low-grade acute toxicities (CTCAE I-II) being reported. The local control rate was 100% after a median follow-up of 27.0 (interquartile range 13.3-58.0) months. PRT resulted in considerable tumor shrinkage, leading to complete remission in five patients and bearing the potential to provide partial or complete symptom relief. Favorable dosimetric outcomes in critical brain substructures by the use of PRT translated into reduced estimated risks for neurocognitive impairment and radiation-induced CNS malignancies compared to XRT. CONCLUSIONS PRT is an effective treatment option for advanced JNA with minimal acute morbidity and the potential for reduced radiation-induced long-term complications.
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Affiliation(s)
- Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Maximilian Deng
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (S.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
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9
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Yamaguchi J, Ohka F, Motomura K, Saito R. Latest classification of ependymoma in the molecular era and advances in its treatment: a review. Jpn J Clin Oncol 2023; 53:653-663. [PMID: 37288489 DOI: 10.1093/jjco/hyad056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
Ependymoma is a rare central nervous system (CNS) tumour occurring in all age groups and is one of the most common paediatric malignant brain tumours. Unlike other malignant brain tumours, ependymomas have few identified point mutations and genetic and epigenetic features. With advances in molecular understanding, the latest 2021 World Health Organization (WHO) classification of CNS tumours divided ependymomas into 10 diagnostic categories based on the histology, molecular information and location; this accurately reflected the prognosis and biology of this tumour. Although maximal surgical resection followed by radiotherapy is considered the standard treatment method, and chemotherapy is considered ineffective, the validation of the role of these treatment modalities continues. Although the rarity and long-term clinical course of ependymoma make designing and conducting prospective clinical trials challenging, knowledge is steadily accumulating and progress is being made. Much of the clinical knowledge obtained from clinical trials to date was based on the previous histology-based WHO classifications, and the addition of new molecular information may lead to more complex treatment strategies. Therefore, this review presents the latest findings on the molecular classification of ependymomas and advances in its treatment.
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Affiliation(s)
- Junya Yamaguchi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Motomura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Montgomery EY, Thirunavu V, Pagadala M, Shlobin NA, Plant-Fox AS, Lam S, DeCuypere M. Recurrent pediatric infratentorial ependymomas: a systematic review and meta-analysis on outcomes and molecular classification. J Neurosurg Pediatr 2023; 31:132-142. [PMID: 36433871 DOI: 10.3171/2022.10.peds22154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to summarize the prognosis of recurrent infratentorial ependymomas based on treatment and molecular characterization. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors searched the PubMed, Scopus, Embase, and Ovid databases for studies on recurrent infratentorial ependymomas in patients younger than 25 years of age. Exclusion criteria included case series of fewer than 5 patients and studies that did not provide time-dependent survival data. RESULTS The authors' database search yielded 482 unique articles, of which 18 were included in the final analysis. There were 479 recurrent infratentorial pediatric ependymomas reported; 53.4% were WHO grade II and 46.6% were WHO grade III tumors. The overall mortality for recurrent infratentorial pediatric ependymomas was 49.1% (226/460). The pooled mean survival was 30.2 months after recurrence (95% CI 22.4-38.0 months). Gross-total resection (GTR) was achieved in 243 (59.0%) patients at initial presentation. The mean survival postrecurrence for those who received initial GTR was 42.3 months (95% CI 35.7-47.6 months) versus 26.0 months (95% CI 9.6-44.6 months) for those who received subtotal resection (STR) (p = 0.032). There was no difference in the mean survival between patients who received GTR (49.3 months, 95% CI 32.3-66.3 months) versus those who received STR (41.4 months, 95% CI 11.6-71.2 months) for their recurrent tumor (p = 0.610). In the studies that included molecular classification data, there were 169 (83.3%) posterior fossa group A (PFA) tumors and 34 (16.7%) posterior fossa group B (PFB) tumors, with 28 tumors harboring a 1q gain. PFA tumors demonstrated worse mean postprogression patient survival (24.7 months, 95% CI 15.3-34.0 months) compared with PFB tumors (48.0 months, 95% CI 32.8-63.2 months) (p = 0.0073). The average postrecurrence survival for patients with 1q+ tumors was 14.7 months. CONCLUSIONS The overall mortality rate for recurrent infratentorial ependymomas was found to be 49.1%, with a pooled mean survival of 30.2 months in the included sample population. More than 80% of recurrent infratentorial ependymomas were of the PFA molecular subtype, and both PFA tumors and those with 1q gain demonstrated worse prognosis after recurrence.
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Affiliation(s)
| | - Vineeth Thirunavu
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Manasa Pagadala
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Nathan A Shlobin
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Ashley S Plant-Fox
- 3Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois; and
| | - Sandi Lam
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael DeCuypere
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Wang Y, Xie C, Xu Y, Zhang Y, Zhu C, Zhou K. Cerebellar irradiation does not cause hyperactivity, fear, and anxiety-related disorders in the juvenile rat brain. Eur Radiol Exp 2022; 6:57. [PMCID: PMC9663786 DOI: 10.1186/s41747-022-00307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The cerebellum is involved in hyperactivity, fear, and anxiety disorders that could be induced by whole-brain irradiation (WBI). However, whether cerebellar irradiation alone (CIA) could induce these disorders is unknown. We investigated the effect of CIA in an animal model.
Methods
Eleven-day-old rat pups underwent a single 3-Gy dose of either WBI (n = 28) or CIA (n = 20), while 34 rat pups were sham-irradiated (controls). Cell death was evaluated in the subgranular zone of the hippocampus by counting pyknotic cells after haematoxylin/eosin staining at 6 h after irradiation for 10, 8, and 9 pups, respectively. Behavioural changes were evaluated via open-field test at 6 weeks for 18, 12, and 25 pups, respectively. Unpaired two-tailed t-test and one-way and two-way repeated ANOVA were used.
Results
Massive cell death in cerebellar external granular layer was detected at 6 h after CIA (1,419 ± 211 mm, mean ± S.E.M. versus controls (68 ± 12 mm) (p < 0.001)), while no significant difference between CIA (1,419 ± 211 mm) versus WBI (1,433 ± 107 mm) (p = 0.955) was found. At open-field behavioural test, running distance, activity, wall distance, middle zone visit times, and duration were higher for WBI versus controls (p < 0.010), but no difference between CIA and controls was found (p > 0.05).
Conclusions
Although the cerebellum is involved in hyperactivity, fear, and anxiety disorders, CIA did not induce these disorders, indicating that WBI-induced cerebellar injury does not directly cause these behavioural abnormalities after WBI. Thus, targeting the cerebellum alone may not be enough to rescue or reduce these behavioural abnormalities after WBI.
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12
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Donahue BR, MacDonald S. Protons for pediatric ependymoma: Where are we now? Neuro Oncol 2022; 24:1203-1204. [PMID: 35294554 PMCID: PMC9248382 DOI: 10.1093/neuonc/noac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bernadine R Donahue
- Department of Radiation Oncology, Maimonides Cancer Center, Brooklyn, New York, USA.,Department of Radiation Oncology, New York University Grossman School of Medicine, New York, New York, USA
| | - Shannon MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, USA
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13
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A prospective behavioral and imaging study exploring the impact on long-term memory of radiotherapy delivered for a brain tumor in childhood and adolescence. Clin Transl Radiat Oncol 2022; 33:7-14. [PMID: 34988299 PMCID: PMC8703178 DOI: 10.1016/j.ctro.2021.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 12/02/2022] Open
Abstract
Common long-term memory defects after pediatric brain tumor affect school achievement The hippocampi, the cerebellum and cerebellar-cortical networks play a role in several memory systems. This study will provide long-term neuropsychological data about four different memory systems. We will investigate the correlations between neuropsychological, neuroimaging and radiotherapy dose data. Imaging will be structural (3DT1), microstructural (DTI), functional (rs-fMRI), vascular (ASL) and metabolic (spectroscopy).
Background Posterior fossa tumors represent two thirds of brain tumors in children. Although progress in treatment has improved survival rates over the past few years, long-term memory impairments in survivors are frequent and have an impact on academic achievement. The hippocampi, cerebellum and cerebellar-cortical networks play a role in several memory systems. They are affected not only by the location of the tumor itself and its surgical removal, but also by the supratentorial effects of complementary treatments, particularly radiotherapy. The IMPALA study will investigate the impact of irradiation doses on brain structures involved in memory, especially the hippocampi and cerebellum. Methods/design In this single-center prospective behavioral and neuro-imaging study, 90 participants will be enrolled in three groups. The first two groups will include patients who underwent surgery for a posterior fossa brain tumor in childhood, who are considered to be cured, and who completed treatment at least 5 years earlier, either with radiotherapy (aggressive brain tumor; Group 1) or without (low-grade brain tumor; Group 2). Group 3 will include control participants matched with Group 1 for age, sex, and handedness. All participants will perform an extensive battery of neuropsychological tests, including an assessment of the main memory systems, and undergo multimodal 3 T MRI. The irradiation dose to the different brain structures involved in memory will be collected from the initial radiotherapy dosimetry. Discussion This study will provide long-term neuropsychological data about four different memory systems (working memory, episodic memory, semantic memory, and procedural memory) and the cognitive functions (attention, language, executive functions) that can interfere with them, in order to better characterize memory deficits among the survivors of brain tumors. We will investigate the correlations between neuropsychological and neuroimaging data on the structural (3DT1), microstructural (DTI), functional (rs-fMRI), vascular (ASL) and metabolic (spectroscopy) impact of the tumor and irradiation dose. This study will thus inform the setting of dose constraints to spare regions linked to the development of cognitive and memory functions. Trial registration ClinicalTrials.gov: NCT04324450, registered March 27, 2020, updated January 25th, 2021. Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT04324450.
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Key Words
- 3DT1, T1-weighted imaging
- CMS, Children's Memory Scale
- DFA, discriminating factor analysis
- DTI, diffusion tensor imaging
- IQ, intellectual quotient
- MEM-III, Wechsler Memory Scale
- Magnetic resonance imaging
- Memory
- NTCP, normal tissue complication probability
- PFT, posterior fossa tumor
- Posterior fossa brain tumor
- Radiotherapy
- SRTT, serial reaction time task
- Spectroscopy
- TCP, tumor control probability
- WAIS, Wechsler Adult Intelligence Scale
- WISC, Wechsler Intelligence Scale for Children
- pCASL, pseudocontinuous arterial spin labeling
- rs-fMRI, resting-state functional magnetic resonance imaging
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14
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Torres VA, Ashford JM, Wright E, Xu J, Zhang H, Merchant TE, Conklin HM. The impact of socioeconomic status (SES) on cognitive outcomes following radiotherapy for pediatric brain tumors: a prospective, longitudinal trial. Neuro Oncol 2021; 23:1173-1182. [PMID: 33543269 DOI: 10.1093/neuonc/noab018] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is a determinant of cognitive and academic functioning among healthy and ill children; however, few pediatric oncology studies examine SES and long-term cognitive functioning. The current study systematically investigated SES as a predictor of cognitive outcomes among children treated for localized brain tumors (BT) with photon radiation therapy (RT). METHODS 248 children treated on a prospective, longitudinal, phase II trial of conformal RT (54-59.4 Gy) for ependymoma, low-grade glioma, or craniopharyngioma were monitored serially with cognitive assessments (intelligence quotient [IQ], reading, math, attention, adaptive function) for 10 years (2209 observations, median age at RT = 6.6 years, 48% male, 80% Caucasian). SES was derived from the Barratt Simplified Measure of Social Status, which incorporates parental occupation, education, and marital status. RESULTS Overall, SES scores fell in the low range (Barratt median = 37). At pre-RT baseline, linear mixed models revealed significant associations between SES and IQ, reading, math, attention, and adaptive function, with higher SES associated with better performance (P < .005). SES predicted change over time in IQ, reading, and math; higher SES was associated with less decline (P < .001). Accounting for sex and age at RT, SES remained predictive of IQ, reading, and math. Analysis of variance revealed a greater relative contribution of SES than sex or age at RT to reading and math. CONCLUSIONS SES represents a novel predictor of cognitive performance before and after RT for pediatric BT. These findings have broad implications as high SES represents a protective factor. Developing interventions to mitigate the effects of low SES is warranted.
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Affiliation(s)
- Victoria A Torres
- Department of Psychology, University of Mississippi, University, Mississippi, USA.,Department of Psychology, Memphis, Tennessee, USA
| | | | | | - Jiahui Xu
- Department of Biostatistics, Memphis, Tennessee, USA
| | - Hui Zhang
- Department of Biostatistics, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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15
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Tsang DS, Kim L, Liu ZA, Janzen L, Khandwala M, Bouffet E, Laperriere N, Dama H, Keilty D, Craig T, Ramaswamy V, Hodgson DC, Mabbott D. Intellectual changes after radiation for children with brain tumors: which brain structures are most important? Neuro Oncol 2021; 23:487-497. [PMID: 33151327 DOI: 10.1093/neuonc/noaa217] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the contribution of radiation dose to different intracranial structures on changes in intellectual function for children with brain tumors. METHODS We evaluated children with brain tumors treated in 2005-2017 who had longitudinal neuropsychological assessments and available photon dosimetric data (if radiation therapy [RT] given). Full Scale Intelligence Quotient (FSIQ) and index scores were evaluated (perceptual reasoning index [PRI], processing speed index [PSI], verbal comprehension index [VCI], and working memory index [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at RT and dose to different brain regions as fixed effects and patient-specific random intercepts. P-values (P*) were adjusted for multiple comparisons. RESULTS Sixty-nine patients were included, 56 of whom received RT. Median neuropsychological follow-up was 3.2 years. Right temporal lobe mean dose was strongly associated with decline in FSIQ (P* = 0.005); with each gray increase in mean dose, there was a decrease of 0.052 FSIQ points per year. Dose to 50% (D50) of the supratentorial brain was associated with decline in PSI (P* = 0.006) and WMI (P* = 0.001). Right and left hippocampus D50 were individually strongly associated with declines in VCI (P* = 0.009 for each). Presence of a ventriculoperitoneal shunt decreased FSIQ by 10 points. CONCLUSIONS We reported associations between dosimetry to specific brain regions and intellectual outcomes, with suggested avoidance structures during RT planning. These models can help clinicians anticipate changes in neurocognition post-RT and guide selection of an optimal RT plan.
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Affiliation(s)
- Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laurence Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Laura Janzen
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children; Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Khandwala
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hitesh Dama
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Dana Keilty
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald Mabbott
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children; Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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16
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Oyefiade A, Paltin I, De Luca CR, Hardy KK, Grosshans DR, Chintagumpala M, Mabbott DJ, Kahalley LS. Cognitive Risk in Survivors of Pediatric Brain Tumors. J Clin Oncol 2021; 39:1718-1726. [PMID: 33886348 DOI: 10.1200/jco.20.02338] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ade Oyefiade
- Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
| | - Iris Paltin
- The Children's Hospital of Philadelphia, Philadelphia, PA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cinzia R De Luca
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kristina K Hardy
- Neuropsychology Division, Children's National Hospital, Washington, DC.,Departments of Psychiatry and Behavioral Sciences and Pediatrics, The George Washington University School of Medicine, Washington, DC
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Murali Chintagumpala
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX
| | - Donald J Mabbott
- Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The University of Toronto, Toronto, ON, Canada
| | - Lisa S Kahalley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Psychology Service, Texas Children's Hospital, Houston, TX
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17
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Cavatorta C, Meroni S, Montin E, Oprandi MC, Pecori E, Lecchi M, Diletto B, Alessandro O, Peruzzo D, Biassoni V, Schiavello E, Bologna M, Massimino M, Poggi G, Mainardi L, Arrigoni F, Spreafico F, Verderio P, Pignoli E, Gandola L. Retrospective study of late radiation-induced damages after focal radiotherapy for childhood brain tumors. PLoS One 2021; 16:e0247748. [PMID: 33635906 PMCID: PMC7909688 DOI: 10.1371/journal.pone.0247748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/15/2021] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To study a robust and reproducible procedure to investigate a relation between focal brain radiotherapy (RT) low doses, neurocognitive impairment and late White Matter and Gray Matter alterations, as shown by Diffusion Tensor Imaging (DTI), in children. METHODS AND MATERIALS Forty-five patients (23 males and 22 females, median age at RT 6.2 years, median age at evaluations 11.1 years) who had received focal RT for brain tumors were recruited for DTI exams and neurocognitive tests. Patients' brains were parceled in 116 regions of interest (ROIs) using an available segmented atlas. After the development of an ad hoc, home-made, multimodal and highly deformable registration framework, we collected mean RT doses and DTI metrics values for each ROI. The pattern of association between cognitive scores or domains and dose or DTI values was assessed in each ROI through both considering and excluding ROIs with mean doses higher than 75% of the prescription. Subsequently, a preliminary threshold value of dose discriminating patients with and without neurocognitive impairment was selected for the most relevant associations. RESULTS The workflow allowed us to identify 10 ROIs where RT dose and DTI metrics were significantly associated with cognitive tests results (p<0.05). In 5/10 ROIs, RT dose and cognitive tests were associated with p<0.01 and preliminary RT threshold dose values, implying a possible cognitive or neuropsychological damage, were calculated. The analysis of domains showed that the most involved one was the "school-related activities". CONCLUSION This analysis, despite being conducted on a retrospective cohort of children, shows that the identification of critical brain structures and respective radiation dose thresholds is achievable by combining, with appropriate methodological tools, the large amount of data arising from different sources. This supported the design of a prospective study to gain stronger evidence.
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Affiliation(s)
- Claudia Cavatorta
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Meroni
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- * E-mail:
| | - Eros Montin
- Department of Electronics Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Maria C. Oprandi
- Neuro-oncological and Neuropsychological Rehabilitation Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mara Lecchi
- Bioinformatics and Biostatistics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Barbara Diletto
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ombretta Alessandro
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Denis Peruzzo
- Neuroimaging Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Bologna
- Department of Electronics Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Geraldina Poggi
- Neuro-oncological and Neuropsychological Rehabilitation Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Luca Mainardi
- Department of Electronics Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Verderio
- Bioinformatics and Biostatistics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Emanuele Pignoli
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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18
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Otterlei OM, Indelicato DJ, Toussaint L, Ytre-Hauge KS, Pilskog S, Fjaera LF, Rørvik E, Pettersen HES, Muren LP, Lassen-Ramshad Y, Di Pinto M, Stokkevåg CH. Variation in relative biological effectiveness for cognitive structures in proton therapy of pediatric brain tumors. Acta Oncol 2021; 60:267-274. [PMID: 33131367 DOI: 10.1080/0284186x.2020.1840626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinically, a constant value of 1.1 is used for the relative biological effectiveness (RBE) of protons, whereas in vitro the RBE has been shown to vary depending on physical dose, tissue type, and linear energy transfer (LET). As the LET increases at the distal end of the proton beam, concerns exist for an elevated RBE in normal tissues. The aim of this study was therefore to investigate the heterogeneity of RBE to brain structures associated with cognition (BSCs) in pediatric suprasellar tumors. MATERIAL AND METHODS Intensity-modulated proton therapy (IMPT) plans for 10 pediatric craniopharyngioma patients were re-calculated using 11 phenomenological and two plan-based variable RBE models. Based on LET, tissue dependence and number of data points used to fit the models, the three RBE models considered the most relevant for the studied endpoint were selected. Thirty BSCs were investigated in terms of RBE and dose/volume parameters. RESULTS For a representative patient, the median (range) dose-weighted mean RBE (RBEd) across all BSCs from the plan-based models was among the lowest (1.09 (1.02-1.52) vs. the phenomenological models at 1.21 (0.78-2.24)). Omitting tissue dependency resulted in RBEd at 1.21 (1.04-2.24). Across all patients, the narrower RBE model selection gave median RBEd values from 1.22 to 1.30. CONCLUSION For all BSCs, there was a systematic model-dependent variation in RBEd, mirroring the uncertainty in biological effects of protons. According to a refined selection of in vitro models, the RBE variation across BSCs was in effect underestimated when using a fixed RBE of 1.1.
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Affiliation(s)
| | | | - Laura Toussaint
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sara Pilskog
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | - Eivind Rørvik
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | | | - Ludvig P. Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marcos Di Pinto
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Camilla H. Stokkevåg
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
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19
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Voshart DC, Wiedemann J, van Luijk P, Barazzuol L. Regional Responses in Radiation-Induced Normal Tissue Damage. Cancers (Basel) 2021; 13:cancers13030367. [PMID: 33498403 PMCID: PMC7864176 DOI: 10.3390/cancers13030367] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Normal tissue side effects remain a major concern in radiotherapy. The improved precision of radiation dose delivery of recent technological developments in radiotherapy has the potential to reduce the radiation dose to organ regions that contribute the most to the development of side effects. This review discusses the contribution of regional variation in radiation responses in several organs. In the brain, various regions were found to contribute to radiation-induced neurocognitive dysfunction. In the parotid gland, the region containing the major ducts was found to be critical in hyposalivation. The heart and lung were each found to exhibit regional responses while also mutually affecting each other's response to radiation. Sub-structures critical for the development of side effects were identified in the pancreas and bladder. The presence of these regional responses is based on a non-uniform distribution of target cells or sub-structures critical for organ function. These characteristics are common to most organs in the body and we therefore hypothesize that regional responses in radiation-induced normal tissue damage may be a shared occurrence. Further investigations will offer new opportunities to reduce normal tissue side effects of radiotherapy using modern and high-precision technologies.
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Affiliation(s)
- Daniëlle C. Voshart
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Julia Wiedemann
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
| | - Lara Barazzuol
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
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20
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Raschke F, Seidlitz A, Wesemann T, Löck S, Jentsch C, Platzek I, Petr J, van den Hoff J, Kotzerke J, Beuthien-Baumann B, Baumann M, Linn J, Krause M, Troost EGC. Dose dependent cerebellar atrophy in glioma patients after radio(chemo)therapy. Radiother Oncol 2020; 150:262-267. [PMID: 32739316 DOI: 10.1016/j.radonc.2020.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy is a standard treatment option for high-grade gliomas. Brain atrophy has previously been associated with radiotherapy. The goal of this study was to investigate dose dependent cerebellar atrophy using prospective, longitudinal MR data from adult glioma patients who received radiotherapy. MATERIALS AND METHODS Cerebellar volumes were measured using T1-weighted MR images from 91 glioma patients before radiotherapy (N = 91) and from longitudinal follow-ups acquired in three monthly intervals (N = 349). Relative cerebellar volumes were calculated as ratios to the corresponding baseline values. Univariate mixed effects models were used to determine factors that were significantly associated with relative cerebellar volumes. These factors were subsequently included as fixed effects in a final multivariate linear mixed effects model. RESULTS In multivariate analysis, cerebellar volume decreased significantly as a function of time (p < 0.001), time × dose (p < 0.001) and patient age (p = 0.007). Considering a 55 year patient receiving a mean cerebellar dose of 0 Gy (10 Gy), the linear mixed effects model predicts a relative cerebellar volume loss of 0.4% (2.0%) after 1 year and 0.7% (3.6%) after 2 years. Compared to patients treated with photons, the cerebellar dose was significantly lower in patients treated with proton therapy (p < 0.001, r = 0.62). CONCLUSION Cerebellar volume decreased significantly and irreversibly after radiotherapy as function of time and mean cerebellar dose. Further work is now needed to correlate these results with cognitive function and motor performance.
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Affiliation(s)
- Felix Raschke
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany.
| | - Annekatrin Seidlitz
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Tim Wesemann
- Institute of Neuroradiology, University Hospital Carl Gustav Carus and Medical Faculty of Technische Universität, Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christina Jentsch
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Ivan Platzek
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Department of Diagnostic and Interventional Radiology, Germany
| | - Jan Petr
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiopharmaceutical Cancer Research, Center for Positron Emission Tomography, Germany
| | - Jörg van den Hoff
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiopharmaceutical Cancer Research, Center for Positron Emission Tomography, Germany
| | - Jörg Kotzerke
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Department of Nuclear Medicine, Germany
| | - Bettina Beuthien-Baumann
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Germany; Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Baumann
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site, Heidelberg, Germany
| | - Jennifer Linn
- Institute of Neuroradiology, University Hospital Carl Gustav Carus and Medical Faculty of Technische Universität, Dresden, Germany
| | - Mechthild Krause
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Esther G C Troost
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
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21
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Modern Radiotherapy for Pediatric Brain Tumors. Cancers (Basel) 2020; 12:cancers12061533. [PMID: 32545204 PMCID: PMC7352417 DOI: 10.3390/cancers12061533] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 12/14/2022] Open
Abstract
Cancer is a leading cause of death in children with tumors of the central nervous system, the most commonly encountered solid malignancies in this population. Radiotherapy (RT) is an integral part of managing brain tumors, with excellent long-term survival overall. The tumor histology will dictate the volume of tissue requiring treatment and the dose. However, radiation in developing children can yield functional deficits and/or cosmetic defects and carries a risk of second tumors. In particular, children receiving RT are at risk for neurocognitive effects, neuroendocrine dysfunction, hearing loss, vascular anomalies and events, and psychosocial dysfunction. The risk of these late effects is directly correlated with the volume of tissue irradiated and dose delivered and is inversely correlated with age. To limit the risk of developing these late effects, improved conformity of radiation to the target volume has come from adopting a volumetric planning process. Radiation beam characteristics have also evolved to achieve this end, as exemplified through development of intensity modulated photons and the use of protons. Understanding dose limits of critical at-risk structures for different RT modalities is evolving. In this review, we discuss the physical basis of the most common RT modalities used to treat pediatric brain tumors (intensity modulated radiation therapy and proton therapy), the RT planning process, survival outcomes for several common pediatric malignant brain tumor histologies, RT-associated toxicities, and steps taken to mitigate the risk of acute and late effects from treatment.
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22
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Greenberger BA, Yock TI. The role of proton therapy in pediatric malignancies: Recent advances and future directions. Semin Oncol 2020; 47:8-22. [PMID: 32139101 DOI: 10.1053/j.seminoncol.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
Proton radiotherapy has promised an advantage in safely treating pediatric malignancies with an increased capability to spare normal tissues, reducing the risk of both acute and late toxicity. The past decade has seen the proliferation of more than 30 proton facilities in the United States, with increased capacity to provide access to approximately 3,000 children per year who will require radiotherapy for their disease. We provide a review of the initial efforts to describe outcomes after proton therapy across the common pediatric disease sites. We discuss the main attempts to assess comparative efficacy between proton and photon radiotherapy concerning toxicity. We also discuss recent efforts of multi-institutional registries aimed at accelerating research to better define the optimal treatment paradigm for children requiring radiotherapy for cure.
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Affiliation(s)
- Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Francis H. Burr Proton Therapy Center, Boston, MA.
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23
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Neurocognitive function and quality of life after proton beam therapy for brain tumour patients. Radiother Oncol 2020; 143:108-116. [DOI: 10.1016/j.radonc.2019.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 11/21/2022]
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24
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Xing X, Jin L, Li Q, Yang Q, Han H, Xu C, Wei Z, Zhan Y, Zhou XS, Xue Z, Chu X, Peng Z, Shi F. Modeling essential connections in obsessive-compulsive disorder patients using functional MRI. Brain Behav 2020; 10:e01499. [PMID: 31893565 PMCID: PMC7010589 DOI: 10.1002/brb3.1499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECT Obsessive-compulsive disorder (OCD) is a mental disease in which people experience uncontrollable and repetitive thoughts or behaviors. Clinical diagnosis of OCD is achieved by using neuropsychological assessment metrics, which are often subjectively affected by psychologists and patients. In this study, we propose a classification model for OCD diagnosis using functional MR images. METHODS Using functional connectivity (FC) matrices calculated from brain region of interest (ROI) pairs, a novel Riemann Kernel principal component analysis (PCA) model is employed for feature extraction, which preserves the topological information in the FC matrices. Hierarchical features are then fed into an ensemble classifier based on the XGBoost algorithm. Finally, decisive features extracted during classification are used to investigate the brain FC variations between patients with OCD and healthy controls. RESULTS The proposed algorithm yielded a classification accuracy of 91.8%. Additionally, the well-known cortico-striatal-thalamic-cortical (CSTC) circuit and cerebellum were found as highly related regions with OCD. To further analyze the cerebellar-related function in OCD, we demarcated cerebellum into three subregions according to their anatomical and functional property. Using these three functional cerebellum regions as seeds for brain connectivity computation, statistical results showed that patients with OCD have decreased posterior cerebellar connections. CONCLUSIONS This study provides a new and efficient method to characterize patients with OCD using resting-state functional MRI. We also provide a new perspective to analyze disease-related features. Despite of CSTC circuit, our model-driven feature analysis reported cerebellum as an OCD-related region. This paper may provide novel insight to the understanding of genetic etiology of OCD.
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Affiliation(s)
- Xiaodan Xing
- Medical Imaging Center, Shanghai Advanced Research Institute, Shanghai, China.,Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Lili Jin
- Center for the Study of Applied Psychology, South China Normal University, Guangzhou, China
| | - Qingfeng Li
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China.,School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Qiong Yang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongying Han
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chuanyong Xu
- Center for the Study of Applied Psychology, South China Normal University, Guangzhou, China
| | - Zhen Wei
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Yiqiang Zhan
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
| | - Xiang Sean Zhou
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
| | - Zhong Xue
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
| | - Xu Chu
- Medical Imaging Center, Shanghai Advanced Research Institute, Shanghai, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ziwen Peng
- Center for the Study of Applied Psychology, South China Normal University, Guangzhou, China.,Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China.,Department of Child Psychiatry, The Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Feng Shi
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
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25
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Toussaint L, Indelicato DJ, Stokkevåg CH, Lassen-Ramshad Y, Pedro C, Mikkelsen R, Di Pinto M, Li Z, Flampouri S, Vestergaard A, Petersen JBB, Schrøder H, Høyer M, Muren LP. Radiation doses to brain substructures associated with cognition in radiotherapy of pediatric brain tumors. Acta Oncol 2019; 58:1457-1462. [PMID: 31271084 DOI: 10.1080/0284186x.2019.1629014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Several brain substructures associated with cognition (BSCs) are located close to typical pediatric brain tumors. Pediatric patients therefore have considerable risks of neurocognitive impairment after brain radiotherapy. In this study, we investigated the radiation doses received by BSCs for three common locations of pediatric brain tumor entities. Material and methods: For ten patients in each group [posterior fossa ependymoma (PFE), craniopharyngioma (CP), and hemispheric ependymoma (HE)], the cumulative fraction of BSCs volumes receiving various dose levels were analyzed. We subsequently explored the differences in dose pattern between the three groups and used available dose response models from the literature to estimate treatment-induced intelligence quotient (IQ) decline. Results: Doses to BSCs were found to differ considerably between the groups, depending on their position relative to the tumor. Large inter-patient variations were observed in the ipsilateral structures of the HE groups, and at low doses for all three groups. IQ decline estimates differed depending on the model applied, presenting larger variations in the HE group. Conclusion: While there were notable differences in the dose patterns between the groups, the extent of estimated IQ decline depended more on the model applied. This inter-model variability should be considered in dose-effect assessments on cognitive outcomes of pediatric patients.
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Affiliation(s)
| | | | - Camilla H. Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | - Catia Pedro
- Department of Radiotherapy, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Ronni Mikkelsen
- Department of Neuroradiology/Biomedicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marcos Di Pinto
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | | | | | - Henrik Schrøder
- Department of pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus, Denmark
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26
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Re-irradiation of locally recurrent pediatric intracranial ependymoma: Experience of the French society of children’s cancer. Radiother Oncol 2019; 132:1-7. [DOI: 10.1016/j.radonc.2018.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
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27
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Merchant TE, Bendel AE, Sabin ND, Burger PC, Shaw DW, Chang E, Wu S, Zhou T, Eisenstat DD, Foreman NK, Fuller CE, Anderson ET, Hukin J, Lau CC, Pollack IF, Laningham FH, Lustig RH, Armstrong FD, Handler MH, Williams-Hughes C, Kessel S, Kocak M, Ellison DW, Ramaswamy V. Conformal Radiation Therapy for Pediatric Ependymoma, Chemotherapy for Incompletely Resected Ependymoma, and Observation for Completely Resected, Supratentorial Ependymoma. J Clin Oncol 2019; 37:974-983. [PMID: 30811284 DOI: 10.1200/jco.18.01765] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Children's Oncology Group trial ACNS0121 estimated event-free survival (EFS) and overall survival for children with intracranial ependymoma treated with surgery, radiation therapy, and-selectively-with chemotherapy. Treatment was administered according to tumor location, histologic grade, and extent of resection. The impacts of histologic grade, focal copy number gain on chromosome 1q, and DNA methylation profiles were studied for those undergoing surgery and immediate postoperative conformal radiation therapy (CRT). METHODS ACNS0121 included 356 newly diagnosed patients (ages 1 to 21 years). Patients with classic supratentorial ependymoma were observed after gross total resection (GTR). Those undergoing subtotal resection received chemotherapy, second surgery, and CRT. The remaining patients received immediate postoperative CRT after near-total resection or GTR. CRT was administered with a 1.0-cm clinical target volume margin. The cumulative total dose was 59.4 Gy, except for patients who underwent GTR and were younger than age 18 months (who received 54 Gy). Patients were enrolled between October 2003 and September 2007 and were observed for 5 years. Supratentorial tumors were evaluated for RELA fusion; infratentorial tumors, for chromosome 1q gain. Classification of posterior fossa groups A and B was made by methylation profiles. RESULTS The 5-year EFS rates were 61.4% (95% CI, 34.5% to 89.6%), 37.2% (95% CI, 24.8% to 49.6%), and 68.5% (95% CI, 62.8% to 74.2%) for observation, subtotal resection, and near-total resection/GTR groups given immediate postoperative CRT, respectively. The 5-year EFS rates differed significantly by tumor grade (P = .0044) but not by age, location, RELA fusion status, or posterior fossa A/posterior fossa B grouping. EFS was higher for patients with infratentorial tumors without 1q gain than with 1q gain (82.8% [95% CI, 74.4% to 91.2%] v 47.4% [95% CI, 26.0% to 68.8%]; P = .0013). CONCLUSION The EFS for patients with ependymoma younger than 3 years of age who received immediate postoperative CRT and for older patients is similar. Irradiation should remain the mainstay of care for most subtypes.
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Affiliation(s)
| | - Anne E Bendel
- 2 Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Noah D Sabin
- 1 St Jude Children's Research Hospital, Memphis, TN
| | - Peter C Burger
- 3 Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, MD
| | | | - Eric Chang
- 5 University of Southern California, Los Angeles, CA.,6 Norris Cancer Center, Los Angeles, CA
| | - Shengjie Wu
- 1 St Jude Children's Research Hospital, Memphis, TN
| | - Tianni Zhou
- 7 California State University, Long Beach, CA
| | - David D Eisenstat
- 8 University of Alberta and University of Alberta Hospital, Edmonton, Alberta, Canada.,9 Edmonton Clinic Health, Edmonton, Alberta, Canada
| | | | | | | | - Juliette Hukin
- 12 British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ching C Lau
- 13 Connecticut Children's Medical Center, Hartford, CT.,15 University of Connecticut School of Medicine, Farmington, CT
| | - Ian F Pollack
- 16 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | | | - Robert H Lustig
- 18 University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Floyd D Armstrong
- 19 University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, FL
| | | | | | | | - Mehmet Kocak
- 1 St Jude Children's Research Hospital, Memphis, TN
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28
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Zapotocky M, Beera K, Adamski J, Laperierre N, Guger S, Janzen L, Lassaletta A, Figueiredo Nobre L, Bartels U, Tabori U, Hawkins C, Urbach S, Tsang DS, Dirks PB, Taylor MD, Bouffet E, Mabbott DJ, Ramaswamy V. Survival and functional outcomes of molecularly defined childhood posterior fossa ependymoma: Cure at a cost. Cancer 2019; 125:1867-1876. [PMID: 30768777 DOI: 10.1002/cncr.31995] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Posterior fossa ependymoma (PFE) comprises 2 groups, PF group A (PFA) and PF group B (PFB), with stark differences in outcome. However, to the authors' knowledge, the long-term outcomes of PFA ependymoma have not been described fully. The objective of the current study was to identify predictors of survival and neurocognitive outcome in a large consecutive cohort of subgrouped patients with PFE over 30 years. METHODS Demographic, survival, and neurocognitive data were collected from consecutive patients diagnosed with PFE from 1985 through 2014 at the Hospital for Sick Children in Toronto, Ontario, Canada. Subgroup was assigned using genome-wide methylation array and/or immunoreactivity to histone H3 K27 trimethylation (H3K27me3). RESULTS A total of 72 PFE cases were identified, 89% of which were PFA. There were no disease recurrences noted among patients with PFB. The 10-year progression-free survival rate for all patients with PFA was poor at 37.1% (95% confidence interval, 25.9%-53.1%). Analysis of consecutive 10-year epochs revealed significant improvements in progression-free survival and/or overall survival over time. This pertains to the increase in the rate of gross (macroscopic) total resection from 35% to 77% and the use of upfront radiotherapy increasing from 65% to 96% over the observed period and confirmed in a multivariable model. Using a mixed linear model, analysis of longitudinal neuropsychological outcomes restricted to patients with PFA who were treated with focal irradiation demonstrated significant continuous declines in the full-scale intelligence quotient over time with upfront conformal radiotherapy, even when correcting for hydrocephalus, number of surgeries, and age at diagnosis (-1.33 ± 0.42 points/year; P = .0042). CONCLUSIONS Data from a molecularly informed large cohort of patients with PFE clearly indicate improved survival over time, related to more aggressive surgery and upfront radiotherapy. However, to the best of the authors' knowledge, the current study is the first, in a subgrouped cohort, to demonstrate that this approach results in reduced neurocognitive outcomes over time.
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Affiliation(s)
- Michal Zapotocky
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Haematology and Oncology, Second Medical School, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kiran Beera
- Programme in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jenny Adamski
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Normand Laperierre
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Sharon Guger
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Janzen
- Programme in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alvaro Lassaletta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Hematology and Oncology, Child Jesus Hospital, Madrid, Spain
| | | | - Ute Bartels
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacey Urbach
- Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek S Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Peter B Dirks
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald J Mabbott
- Programme in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
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Ruble K, Paré-Blagoev J, Cooper S, Martin A, Jacobson LA. Parent perspectives on oncology team communication regarding neurocognitive impacts of cancer therapy and school reentry. Pediatr Blood Cancer 2019; 66:e27427. [PMID: 30160071 DOI: 10.1002/pbc.27427] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neurocognitive deficits are common after childhood cancer and impact academic performance. Parents need to be knowledgeable of long-term complications impacting school and the resources necessary to support educational achievement. The oncology team plays an important role in preparing parents for the challenges of returning to school after treatment. METHODS An online survey developed by parents and stakeholders was used to assess parent experiences and preferences associated with oncology team support around neurocognitive deficits and school transition. Recruitment included social media sites, foundation contacts, and clinic/event flyers. Topics included information content, timing, and frequency of information; and utility or perceived value of information. Inclusion criteria included respondent identifying as a parent (caregiver) of child treated for cancer who has returned to school. RESULTS Surveys from 203 parents were completed representing diverse geographic locations. Nearly half (48%) did not recall receiving information about neurocognitive deficits. The most frequently reported time to receive this information was at diagnosis, but parents reported a need for conversations throughout the cancer trajectory, especially at transition to survivorship and school reentry. In addition, half of the parents (51%) felt inadequately prepared for the return to school. Information about neuropsychological testing, resources for learning difficulties, educational terms, and legal rights related to school services were the topics most inadequately provided. CONCLUSIONS Parents feel inadequately prepared by their oncology team for their child's return to school. Research is needed to identify effective oncology team approaches to fill the gaps in knowledge around school reentry after cancer treatment.
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Affiliation(s)
- Kathy Ruble
- Department of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Stacy Cooper
- Department of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allison Martin
- Department of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa A Jacobson
- Department of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
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30
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Yecies D, Azad TD, Esparza R, Quon JL, Forkert ND, MacEachern SJ, Bruckert L, Maleki M, Edwards MSB, Grant GA, Yeom KW. Long-Term Supratentorial Radiologic Effects of Surgery and Local Radiation in Children with Infratentorial Ependymoma. World Neurosurg 2018; 122:e1300-e1304. [PMID: 30448581 DOI: 10.1016/j.wneu.2018.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Current standard of care for children with infratentorial ependymoma includes maximal safe resection and local radiation of 54-59 Gray. High-dose local radiation has been associated with declines in multiple cognitive domains. The anatomic and physiologic correlates of this cognitive decline remain undefined, and there have been no radiographic studies on the long-term effects of this treatment paradigm. METHODS A comprehensive database of pediatric brain tumor patients treated at Stanford Children's from 2004-2016 was queried. Seven patients with posterior fossa ependymoma who were treated with surgery and local radiation alone, who had no evidence of recurrent disease, and had imaging suitable for analysis were identified. Diffusion-weighted magnetic resonance imaging datasets were used to calculate apparent diffusion coefficient maps for each subject, while arterial spin labeling datasets were used to calculate maps of cerebral blood flow. Diffusion-weighted imaging and arterial spin labeling datasets of 52 age-matched healthy children were analyzed in the same fashion to enable group comparisons. RESULTS Several statistically significant differences were detected between the 2 groups. Cerebral blood flow was lower in the caudate and pallidum and higher in the nucleus accumbens in the ependymoma cohort compared with controls. Apparent diffusion coefficient was increased in the thalamus and trended toward decreased in the amygdala. CONCLUSIONS Surgery and local radiation for posterior fossa ependymoma are associated with supratentorial apparent diffusion coefficient and cerebral blood flow alterations, which may represent an anatomic and physiologic correlate to the previously published decline in neurocognitive outcomes in this population.
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Affiliation(s)
- Derek Yecies
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| | - Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Rogelio Esparza
- Department of Neurosurgery, NYU School of Medicine, New York, New York, USA
| | - Jennifer L Quon
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nils D Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sarah J MacEachern
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Bruckert
- Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Maryam Maleki
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Michael S B Edwards
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kristen W Yeom
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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31
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Radiation dose constraints for organs at risk in neuro-oncology; the European Particle Therapy Network consensus. Radiother Oncol 2018; 128:26-36. [PMID: 29779919 DOI: 10.1016/j.radonc.2018.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/16/2018] [Accepted: 05/01/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE For unbiased comparison of different radiation modalities and techniques, consensus on delineation of radiation sensitive organs at risk (OARs) and on their dose constraints is warranted. Following the publication of a digital, online atlas for OAR delineation in neuro-oncology by the same group, we assessed the brain OAR-dose constraints in a follow-up study. METHODS We performed a comprehensive search to identify the current papers on OAR dose constraints for normofractionated photon and particle therapy in PubMed, Ovid Medline, Cochrane Library, Embase and Web of Science. Moreover, the included articles' reference lists were cross-checked for potential studies that met the inclusion criteria. Consensus was reached among 20 radiation oncology experts in the field of neuro-oncology. RESULTS For the OARs published in the neuro-oncology literature, we summarized the available literature and recommended dose constraints associated with certain levels of normal tissue complication probability (NTCP) according to the recent ICRU recommendations. For those OARs with lacking or insufficient NTCP data, a proposal for effective and efficient data collection is given. CONCLUSION The use of the European Particle Therapy Network-consensus OAR dose constraints summarized in this article is recommended for the model-based approach comparing photon and proton beam irradiation as well as for prospective clinical trials including novel radiation techniques and/or modalities.
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32
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Doger de Spéville E, Kieffer V, Dufour C, Grill J, Noulhiane M, Hertz-Pannier L, Chevignard M. Neuropsychological consequences of childhood medulloblastoma and possible interventions: A review. Neurochirurgie 2018; 67:90-98. [PMID: 29716738 DOI: 10.1016/j.neuchi.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 03/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Children who have been treated for a medulloblastoma often suffer long-term cognitive impairments that often negatively affect their academic performance and quality of life. In this article, we will review the neuropsychological consequences of childhood medulloblastoma and discuss the risk factors known to influence the presence and severity of these cognitive impairments and possible interventions to improve their quality of life. METHODS This narrative review was based on electronic searches of PubMed to identify all relevant studies. RESULTS Although many types of cognitive impairments often emerge during a child's subsequent development, the core cognitive domains that are most often affected in children treated for a medulloblastoma are processing speed, attention and working memory. The emergence and magnitude of these deficits varies greatly among patients. They are influenced by demographic (age at diagnosis, parental education), medical and treatment-related factors (perioperative complications, including posterior fossa syndrome, radiation therapy dose, etc.), and the quality of interventions such as school adaptations provided to the child or rehabilitation programs that focus on cognitive skills, behavior and psychosocial functioning. CONCLUSION These patients require specialized and coordinated multidisciplinary rehabilitation follow-up that provides timely and adapted assessments and culminates in personalized intervention goals being set with the patient and the family. Follow-up should be continued until referral to adult services.
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Affiliation(s)
- E Doger de Spéville
- Inserm U1129, CEA, Paris Descartes university, 75005 Paris, France; UNIACT, institut Joliot, DRF, Neurospin, CEA, Paris Saclay university, 91190 Gif-sur-Yvette, France; Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France
| | - V Kieffer
- Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France; CSI (Outreach team for children and adolescents with acquired brain injury), department for children with acquired brain injury, hôpitaux de Saint-Maurice, 94410 Saint-Maurice, France
| | - C Dufour
- Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France
| | - J Grill
- Department of pediatric and adolescent oncology, Gustave-Roussy, 94800 Villejuif, France
| | - M Noulhiane
- Inserm U1129, CEA, Paris Descartes university, 75005 Paris, France; UNIACT, institut Joliot, DRF, Neurospin, CEA, Paris Saclay university, 91190 Gif-sur-Yvette, France
| | - L Hertz-Pannier
- Inserm U1129, CEA, Paris Descartes university, 75005 Paris, France; UNIACT, institut Joliot, DRF, Neurospin, CEA, Paris Saclay university, 91190 Gif-sur-Yvette, France
| | - M Chevignard
- CSI (Outreach team for children and adolescents with acquired brain injury), department for children with acquired brain injury, hôpitaux de Saint-Maurice, 94410 Saint-Maurice, France; Rehabilitation department for children with acquired neurological injury, and outreach team for children and adolescents with acquired brain injury, Saint-Maurice hospitals, 14, rue du Val-d'Osne, 94410 Saint-Maurice, France; Sorbonne université, laboratoire d'imagerie biomédicale, LIB, 75006 Paris, France; GRC n(o) 18, handicap cognitif et réadaptation (HanCRe)- Sorbonne université, 75013 Paris, France.
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33
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Galle JO, Long DE, Lautenschlaeger T, Zellars RC, Watson GA, Ellsworth SG. Effects of Proton Center Closure on Pediatric Case Volume and Resident Education at an Academic Cancer Center. Int J Radiat Oncol Biol Phys 2018; 100:710-718. [DOI: 10.1016/j.ijrobp.2017.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/18/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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34
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Boström M, Kalm M, Eriksson Y, Bull C, Ståhlberg A, Björk-Eriksson T, Hellström Erkenstam N, Blomgren K. A role for endothelial cells in radiation-induced inflammation. Int J Radiat Biol 2018; 94:259-271. [PMID: 29359989 DOI: 10.1080/09553002.2018.1431699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To unravel the role of the vasculature in radiation-induced brain tissue damage. MATERIALS AND METHODS Postnatal day 14 mice received a single dose of 10 Gy cranial irradiation and were sacrificed 6 h, 24 h or 7 days post-irradiation. Endothelial cells were isolated from the hippocampus and cerebellum using fluorescence-activated cell sorting, followed by cell cycle analysis and gene expression profiling. RESULTS Flow cytometric analysis revealed that irradiation increased the percentage of endothelial cells, relative to the whole cell population in both the hippocampus and the cerebellum. This change in cell distribution indicates that other cell types are more susceptible to irradiation-induced cell death, compared to endothelial cells. This was supported by data showing that genes involved in endothelial cell-specific apoptosis (e.g. Smpd1) were not induced at any time point investigated but that genes involved in cell-cycle arrest (e.g. Cdkn1a) were upregulated at all investigated time points, indicating endothelial cell repair. Inflammation-related genes, on the other hand, were strongly induced, such as Ccl2, Ccl11 and Il6. CONCLUSIONS We conclude that endothelial cells are relatively resistant to ionizing radiation but that they play an active, hitherto unknown, role in the inflammatory response after irradiation. In the current study, this was shown in both the hippocampus, where neurogenesis and extensive cell death after irradiation occurs, and in the cerebellum, where neurogenesis no longer occurs at this developmental age.
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Affiliation(s)
- Martina Boström
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden.,b Department of Oncology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden.,c Department of Pharmacology , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Marie Kalm
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden.,c Department of Pharmacology , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Yohanna Eriksson
- c Department of Pharmacology , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Cecilia Bull
- b Department of Oncology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - Anders Ståhlberg
- d Department of Pathology and Genetics , Sahlgrenska Cancer Centre, Institute of Biomedicine, University of Gothenburg , Gothenburg , Sweden
| | - Thomas Björk-Eriksson
- b Department of Oncology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - Nina Hellström Erkenstam
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden
| | - Klas Blomgren
- a Center for Brain Repair and Rehabilitation , Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg , Sweden.,e Department of Pediatric Oncology , Karolinska University Hospital , Stockholm , Sweden.,f Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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35
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Eekers DBP, In 't Ven L, Deprez S, Jacobi L, Roelofs E, Hoeben A, Lambin P, de Ruysscher D, Troost EGC. The posterior cerebellum, a new organ at risk? Clin Transl Radiat Oncol 2017; 8:22-26. [PMID: 29594239 PMCID: PMC5862675 DOI: 10.1016/j.ctro.2017.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/03/2022] Open
Abstract
Eekers et al. have recently proposed a neuro-oncology atlas, which was co-authored by most centers associated in the European Proton Therapy Network (EPTN; Figure 1). With the introduction of new treatment techniques, such as integrated magnetic resonance imaging and linear accelerators (MR-linac) or particle therapy, the prediction of clinical efficacy of these more costly treatment modalities becomes more relevant. One of the side-effects of brain irradiation, being cognitive decline, is one of the toxicities most difficult to measure and predict. In order to validly compare different treatment modalities, 1) a uniform nomenclature of the organs at risk (OARs), 2) uniform atlas-based delineation [e.g., Eekers et al.], 3) long-term follow-up data with standardized cognitive tests, 4) a large patient population, and 5) (thus derived) validated normal tissue complication probability (NTCP) models are mandatory. Apart from the Gondi model, in which the role of the dose to 40% of both hippocampi (HC) proves to be significantly related to cognition in 18 patients, no similar models are available. So there is a strong need for more NTCP models, on HC, brain tissue and possible other relevant brain structures. In this review we summarize the available evidence on the role of the posterior cerebellum as a possible new organ at risk for cognition, which is deemed relevant for irradiation of brain and head and neck tumors.
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Affiliation(s)
- Daniëlle B P Eekers
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Proton Therapy Department South-East Netherlands (ZON-PTC), Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lieke In 't Ven
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Jacobi
- Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ann Hoeben
- Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philippe Lambin
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esther G C Troost
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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36
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Monte Carlo-driven predictions of neurocognitive and hearing impairments following proton and photon radiotherapy for pediatric brain-tumor patients. J Neurooncol 2017; 135:521-528. [DOI: 10.1007/s11060-017-2597-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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Doger de Speville E, Robert C, Perez-Guevara M, Grigis A, Bolle S, Pinaud C, Dufour C, Beaudré A, Kieffer V, Longaud A, Grill J, Valteau-Couanet D, Deutsch E, Lefkopoulos D, Chiron C, Hertz-Pannier L, Noulhiane M. Relationships between Regional Radiation Doses and Cognitive Decline in Children Treated with Cranio-Spinal Irradiation for Posterior Fossa Tumors. Front Oncol 2017; 7:166. [PMID: 28868253 PMCID: PMC5563322 DOI: 10.3389/fonc.2017.00166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/25/2017] [Indexed: 12/25/2022] Open
Abstract
Pediatric posterior fossa tumor (PFT) survivors who have been treated with cranial radiation therapy often suffer from cognitive impairments that might relate to IQ decline. Radiotherapy (RT) distinctly affects brain regions involved in different cognitive functions. However, the relative contribution of regional irradiation to the different cognitive impairments still remains unclear. We investigated the relationships between the changes in different cognitive scores and radiation dose distribution in 30 children treated for a PFT. Our exploratory analysis was based on a principal component analysis (PCA) and an ordinary least square regression approach. The use of a PCA was an innovative way to cluster correlated irradiated regions due to similar radiation therapy protocols across patients. Our results suggest an association between working memory decline and a high dose (equivalent uniform dose, EUD) delivered to the orbitofrontal regions, whereas the decline of processing speed seemed more related to EUD in the temporal lobes and posterior fossa. To identify regional effects of RT on cognitive functions may help to propose a rehabilitation program adapted to the risk of cognitive impairment.
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Affiliation(s)
- Elodie Doger de Speville
- INSERM U1129, CEA, Paris Descartes University, Paris, France.,UNIACT, Institut Joliot, DRF, Neurospin, CEA, Paris Saclay University, Gif-sur-Yvette, France.,Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Charlotte Robert
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM, U1030, Villejuif, France.,Paris Sud University, Paris-Saclay University, Villejuif, France.,Gustave Roussy, Paris-Saclay University, Department of Medical Physics, Villejuif, France
| | | | - Antoine Grigis
- Institut Joliot, Neurospin, CEA, Paris-Saclay University, Gif-sur-Yvette, France
| | - Stephanie Bolle
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Clemence Pinaud
- INSERM U1129, CEA, Paris Descartes University, Paris, France.,UNIACT, Institut Joliot, DRF, Neurospin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Anne Beaudré
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,Gustave Roussy, Paris-Saclay University, Department of Medical Physics, Villejuif, France
| | - Virginie Kieffer
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France.,CSI Department for Children with Acquired Brain Injury, Hopitaux de Saint Maurice, Saint-Maurice, France
| | - Audrey Longaud
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France.,Paris Sud University, Orsay, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France.,Paris Sud University, Orsay, France
| | - Dominique Valteau-Couanet
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France.,Paris Sud University, Orsay, France
| | - Eric Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM, U1030, Villejuif, France.,Paris Sud University, Paris-Saclay University, Villejuif, France.,Gustave Roussy, Paris-Saclay University, Department of Medical Physics, Villejuif, France
| | - Dimitri Lefkopoulos
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,Gustave Roussy, Paris-Saclay University, Department of Medical Physics, Villejuif, France
| | - Catherine Chiron
- INSERM U1129, CEA, Paris Descartes University, Paris, France.,UNIACT, Institut Joliot, DRF, Neurospin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - Lucie Hertz-Pannier
- INSERM U1129, CEA, Paris Descartes University, Paris, France.,UNIACT, Institut Joliot, DRF, Neurospin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - Marion Noulhiane
- INSERM U1129, CEA, Paris Descartes University, Paris, France.,UNIACT, Institut Joliot, DRF, Neurospin, CEA, Paris Saclay University, Gif-sur-Yvette, France
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38
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Badiyan SN, Ulmer S, Ahlhelm FJ, Fredh ASM, Kliebsch U, Calaminus G, Bolsi A, Albertini F, Leiser D, Timmermann B, Malyapa RS, Schneider R, Lomax AJ, Weber DC. Clinical and Radiologic Outcomes in Adults and Children Treated with Pencil-Beam Scanning Proton Therapy for Low-Grade Glioma. Int J Part Ther 2017; 3:450-460. [PMID: 31772995 PMCID: PMC6871558 DOI: 10.14338/ijpt-16-00031.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/29/2017] [Indexed: 09/21/2023] Open
Abstract
PURPOSE We assessed clinical and radiologic outcomes in adults and children with low-grade glioma (LGG) of the brain treated with pencil-beam scanning (PBS) proton therapy (PT). MATERIALS AND METHODS Between 1997 and 2014, 28 patients were treated with PBS PT, 20 (71%) of whom were younger than 18 years. Median age at start of PT was 12.3 years (range, 2.2-53.0 years). Nine patients (32%) underwent at least a subtotal resection; 12 (43%) underwent biopsy; and 7 (25%) were diagnosed radiographically. Twelve patients (43%) had grade II and 9 (32%) had grade I gliomas. Eleven patients (39%) received chemotherapy before PT. A median dose of 54 Gy (relative biologic effectiveness) was administered. Radiologic response to PT was determined using the Response Evaluation Criteria in Solid Tumors (RECIST). Eight domains of quality of life (QoL) for 16 pediatric patients were assessed prospectively by patients' parents using the pediatric QoL proxy questionnaire. Progression-free survival and overall survival (OS) were estimated by the Kaplan-Meier method. Median follow-up was 42.1 months for living patients. RESULTS Ten patients (36%) developed local, clinical failure. Three patients (11%) died, all of tumor progression. Radiographic tumor response by RECIST was evaluable in 11 patients: 9 (82%) with stable disease, 1 (9%) with partial response, and 1 (9%) with complete response to PT. Three-year OS and progression-free survival were 83.4% and 56.0%, respectively. No ≥ grade III acute toxicities were observed. Grade III, late radiation necrosis developed in 1 patient (4%). No appreciable change in pediatric QoL proxy scores in children was noted in any of the 8 domains at any time point. CONCLUSION Treatment with PBS PT is effective for LGG, with minimal acute toxicity and, in children, no appreciable decline in QoL. More patients and longer follow-up are needed to determine the long-term efficacy and toxicity of PT for LGG.
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Affiliation(s)
- Shahed N. Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Frank J. Ahlhelm
- Department of Radiology, Cantonal Hospital Baden, Baden, Switzerland
| | - Anna S. M. Fredh
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | | | - Beate Timmermann
- Clinic for Particle Therapy, West German Proton Center, University Hospital Essen, Germany
| | - Robert S. Malyapa
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ralf Schneider
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, Swiss Institute of Technology, Zurich, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
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39
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Fjæra LF, Li Z, Ytre-Hauge KS, Muren LP, Indelicato DJ, Lassen-Ramshad Y, Engeseth GM, Brydøy M, Mairani A, Flampouri S, Dahl O, Stokkevåg CH. Linear energy transfer distributions in the brainstem depending on tumour location in intensity-modulated proton therapy of paediatric cancer. Acta Oncol 2017; 56:763-768. [PMID: 28423966 DOI: 10.1080/0284186x.2017.1314007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND For tumours near organs at risk, there is concern about unintended increase in biological dose from elevated linear energy transfer (LET) at the distal end of treatment fields. The objective of this study was therefore to investigate how different paediatric posterior fossa tumour locations impact LET and biological dose to the brainstem during intensity-modulated proton therapy (IMPT). MATERIAL AND METHODS Multiple IMPT plans were generated for four different simulated tumour locations relative to the brainstem for a five-year-old male patient. A prescribed dose of 59.4 Gy(RBE) was applied to the planning target volumes (PTVs). Plans with two lateral and one posterior non-coplanar fields were created, along with plans with modified field arrangements. The dose-averaged LET (LETd) and the physical dose × RBELET (D × RBELET), where RBELET=1+c × LETd, were calculated using the FLUKA Monte Carlo code. A scaling parameter c was applied to make the RBELET represent variations in the biological effect due to LET. RESULTS High LETd values surrounded parts of the PTV and encompassed portions of the brainstem. Mean LETd values in the brainstem were 3.2-6.6 keV/μm. The highest absolute brainstem LETd values were seen with the tumour located most distant from the brainstem, whereas lower and more homogeneous LETd values were seen when the tumour invaded the brainstem. In contrast, the highest mean D × RBELET values were found in the latter case (54.0 Gy(RBE)), while the case with largest distance between tumour and brainstem had a mean D × RBELET of 1.8 Gy(RBE). CONCLUSIONS Using IMPT to treat posterior fossa tumours may result in high LETd values within the brainstem, particularly if the tumour volume is separated from the brainstem. However, the D × RBELET was greater for tumours that approached or invaded the brainstem. Changing field angles showed a reduction of LETd and D × RBELET in the brainstem.
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Affiliation(s)
- Lars Fredrik Fjæra
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | | | - Ludvig P. Muren
- Department of Medical Physics, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Grete May Engeseth
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Marianne Brydøy
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Andrea Mairani
- Medical Physics Unit, CNAO Foundation, Pavia, Italy
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Olav Dahl
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Camilla H. Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
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40
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Radiation induces progenitor cell death, microglia activation, and blood-brain barrier damage in the juvenile rat cerebellum. Sci Rep 2017; 7:46181. [PMID: 28382975 PMCID: PMC5382769 DOI: 10.1038/srep46181] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/10/2017] [Indexed: 02/03/2023] Open
Abstract
Posterior fossa tumors are the most common childhood intracranial tumors, and radiotherapy is one of the most effective treatments. However, irradiation induces long-term adverse effects that can have significant negative impacts on the patient’s quality of life. The purpose of this study was to characterize irradiation-induced cellular and molecular changes in the cerebellum. We found that irradiation-induced cell death occurred mainly in the external germinal layer (EGL) of the juvenile rat cerebellum. The number of proliferating cells in the EGL decreased, and 82.9% of them died within 24 h after irradiation. Furthermore, irradiation induced oxidative stress, microglia accumulation, and inflammation in the cerebellum. Interestingly, blood-brain barrier damage and blood flow reduction was considerably more pronounced in the cerebellum compared to other brain regions. The cerebellar volume decreased by 39% and the migration of proliferating cells to the internal granule layer decreased by 87.5% at 16 weeks after irradiation. In the light of recent studies demonstrating that the cerebellum is important not only for motor functions, but also for cognition, and since treatment of posterior fossa tumors in children typically results in debilitating cognitive deficits, this differential susceptibility of the cerebellum to irradiation should be taken into consideration for future protective strategies.
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41
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The Role of the Pediatric Cerebellum in Motor Functions, Cognition, and Behavior: A Clinical Perspective. Neuroimaging Clin N Am 2017; 26:317-29. [PMID: 27423796 DOI: 10.1016/j.nic.2016.03.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article discusses the contribution of the pediatric cerebellum to locomotion, ocular motor control, speech articulation, cognitive function, and behavior modulation. Hypotheses on cerebellar function are discussed. Clinical features in patients with cerebellar disorders are outlined. Cerebellar abnormalities in cognitive and behavioral disorders are detailed.
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42
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Estabrook NC, Hoene TA, Carlin PS, McDonald MW. Quantifying Proton Fields for Midline Brain Tumors: A Benefit/Cost Analysis of Planning Objectives. Int J Part Ther 2016; 3:13-20. [PMID: 31772971 PMCID: PMC6871579 DOI: 10.14338/ijpt-15-00039.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/13/2016] [Indexed: 07/23/2024] Open
Abstract
PURPOSE We sought to quantify the optimum number of beams by using a midline sagittal arrangement for midline brain tumors when considering the competing demands of a high degree of target conformation and maximizing reduction of nontarget brain dose. The volume of nontarget brain tissue receiving between 5 and 20 Gy (V5-V20) was selected to measure "low-dose bath" to normal brain. MATERIALS AND METHODS An exploratory model was developed with 6 midline brain targets created by using spheres of 1-, 3-, and 5-cm diameters located in superficial and deep locations. For each, five 3-dimensional proton treatment plans with uniform beam scanning were generated by using 1 to 5 fields. Dose-volume histograms were analyzed to calculate conformation number and V5-V20. A benefit/cost analysis was performed to determine the marginal gain in conformation number and the marginal cost of V5-V20 for the addition of each field and hypothesize the optimum number of treatment fields. We tested our hypothesis by re-planning 10 actual patient tumors with the same technique to compare the averages of these 50 plans to our model. RESULTS Our model and validation cohort demonstrated the largest marginal benefit in target conformation and the lowest marginal cost in normal brain V5-V20 with the addition of a second proton field. The addition of a third field resulted in a relative marginal benefit in target conformation of just 3.9% but a relative marginal cost in V5-V20 of 78.7%. Normal brain absolute V5-V20 increased in a nearly linear fashion with each additional field. CONCLUSIONS When treating midline brain lesions with 3-dimensional proton therapy in an array of midline sagittal beams, our model suggests the most appropriate number of fields is 2. There was little marginal benefit in target conformation and increasing cost of normal brain dose when increasing the number of fields beyond this.
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Affiliation(s)
- Neil C. Estabrook
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ted A. Hoene
- Indiana University Health Proton Therapy Center, Bloomington, IN, USA
| | - Paul S. Carlin
- Department of Economics, Indiana University – Purdue University Indianapolis, Indianapolis, IN, USA
| | - Mark W. McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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43
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Brinkman TM, Krasin MJ, Liu W, Armstrong GT, Ojha RP, Sadighi ZS, Gupta P, Kimberg C, Srivastava D, Merchant TE, Gajjar A, Robison LL, Hudson MM, Krull KR. Long-Term Neurocognitive Functioning and Social Attainment in Adult Survivors of Pediatric CNS Tumors: Results From the St Jude Lifetime Cohort Study. J Clin Oncol 2016; 34:1358-67. [PMID: 26834063 DOI: 10.1200/jco.2015.62.2589] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the prevalence and severity of neurocognitive impairment in adult survivors of pediatric CNS tumors and to examine associated treatment exposures. PATIENTS AND METHODS Participants included 224 survivors of CNS tumors who were treated at St Jude Children's Research Hospital (current median age [range], 26 years [19 to 53 years]; time from diagnosis, 18 years [11 to 42 years]) and completed neurocognitive testing. Information on cranial radiation therapy (CRT) doses and parameters of delivery were abstracted from medical records. The prevalence of severe impairment (ie, at least two standard deviations below normative mean) was compared across radiation treatment groups (no CRT, focal irradiation, craniospinal irradiation) using the χ(2) test. Log-binomial models were used to estimate risk ratios (RRs) and corresponding 95% CIs for severe impairment. RESULTS In multivariable models, craniospinal irradiation was associated with a 1.5- to threefold increased risk of severe impairment compared with no CRT (eg, intelligence: RR = 2.70; 95% CI, 1.37 to 5.34; memory: RR = 2.93; 95% CI, 1.69 to 5.08; executive function: RR = 1.74; 95% CI, 1.24 to 2.45). Seizures were associated with impaired academic performance (RR = 1.48; 95% CI, 1.02 to 2.14), attention (RR = 1.54; 95% CI, 1.12 to 2.13), and memory (RR = 1.44; 95% CI, 1.04 to 1.99). Hydrocephalus with shunt placement was associated with impaired intelligence (RR = 1.78; 95% CI, 1.12 to 2.82) and memory (RR = 1.42; 95% CI, 1.03 to 1.95). Differential follow-up time contributed to variability in prevalence estimates between survivors treated with older nonconformal and those treated with more contemporary conformal radiation therapy methods. Neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living. CONCLUSION Survivors of pediatric CNS tumors are at risk of severe neurocognitive impairment in adulthood. The prevalence of severe impairment is greater than expected in the general population, even in the absence of CRT, and is associated with disrupted attainment of adult social milestones.
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Affiliation(s)
- Tara M Brinkman
- All authors: St Jude Children's Research Hospital, Memphis, TN.
| | | | - Wei Liu
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | | | - Rohit P Ojha
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | - Zsila S Sadighi
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | - Pankaj Gupta
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | - Cara Kimberg
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | | | | | - Amar Gajjar
- All authors: St Jude Children's Research Hospital, Memphis, TN
| | | | | | - Kevin R Krull
- All authors: St Jude Children's Research Hospital, Memphis, TN
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Abstract
Radiotherapy (RT) of the brain is associated with significant stigma in the neuro-oncology community. This is primarily because of the potentially severe complications with which it may be associated. These complications, especially in subacute and latent settings, are often unpredictable, potentially progressive, and irreversible. The onset of complications may start from the first fraction of 2 Gy, continuing over several months after end of RT with persistent drowsiness and apathy. It may also extend over many years with progressive onset of neurocognitive impairments such as memory decline, and diminished focus/attention. For long-term survivors, such as young patients irradiated for a favorable low-grade glioma, quality of life can be seriously impacted by RT. It is essential, as in the pediatric field, to propose patient-specific regimens from the very outset of therapy. The use of molecular biomarkers to better predict survival, control of comorbidities along with judicious use of medications such as steroids and antiepileptics, improved targeting with the help of modern imaging and RT techniques, modulation of the dose, and fractionation aimed at limiting integral dose to the healthy brain all have the potential to minimize treatment-related complications while maintaining the therapeutic efficacy for which RT is known. Sparing "radiosensitive" areas such as hippocampi could have a modest but measurable impact with regard to cognitive preservation, an effect that can possibly be enhanced when used in conjunction with memantine and/or donepezil.
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45
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Annett RD, Patel SK, Phipps S. Monitoring and Assessment of Neuropsychological Outcomes as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S460-513. [PMID: 26700917 DOI: 10.1002/pbc.25749] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/13/2015] [Indexed: 11/07/2022]
Abstract
Central nervous system cancers or exposure to CNS-directed therapies increase risk for neuropsychological deficits. There are no accepted guidelines for assessment of neuropsychological functioning in this population. A multifaceted literature search was conducted and relevant literature reviewed to inform the guidelines. Studies of neuropsychological outcomes are widely documented in the pediatric oncology literature. There is strong evidence of need for neuropsychological assessment, but insufficient evidence to guide the timing of assessment, nor to recommend specific interventions. Children with brain tumors and others at high risk for neuropsychological deficits should be monitored and assessed for neuropsychological deficits.
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Affiliation(s)
- Robert D Annett
- Universityof Mississippi Medical Center, Jackson, Mississippi
| | - Sunita K Patel
- City of Hope Medical Center and Beckman Research Institute, Duarte, California
| | - Sean Phipps
- St. Jude Children's Hospital, Memphis, Tennessee
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46
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Crellin AM, Burnet NG. Proton beam therapy: the context, future direction and challenges become clearer. Clin Oncol (R Coll Radiol) 2014; 26:736-8. [PMID: 25455384 DOI: 10.1016/j.clon.2014.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Affiliation(s)
- A M Crellin
- NHS England National Clinical Lead Proton Beam Therapy, UK; St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK; NCRI Clinical and Translational Radiotherapy Research Working Group (CTRad), UK
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