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Siegel BI, Gust J. How Cancer Harms the Developing Brain: Long-Term Outcomes in Pediatric Cancer Survivors. Pediatr Neurol 2024; 156:91-98. [PMID: 38735088 DOI: 10.1016/j.pediatrneurol.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 02/22/2024] [Accepted: 03/31/2024] [Indexed: 05/14/2024]
Abstract
Survival rates for pediatric cancer are improving, resulting in a rising need to understand and address long-term sequelae. In this narrative review, we summarize the effects of cancer and its treatment on the developing brain, with a focus on neurocognitive function in leukemia and pediatric brain tumor survivors. We then discuss possible mechanisms of brain injury and management considerations.
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Affiliation(s)
- Benjamin I Siegel
- Brain Tumor Institute, Children's National Hospital, Washington, District of Columbia; Division of Pediatric Hematology and Oncology, Children's National Hospital, Washington, District of Columbia
| | - Juliane Gust
- Department of Neurology, University of Washinton, Seattle, Washington; Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington.
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Lam KKW, Ho KY, Liu APK, Liu CQ, Ng MH, Lam TC, Belay GM, Hammoda AO, Yang F, Yuen WM, Chan GCF. Effectiveness of Computerized Cognitive Training on Working Memory in Pediatric Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00234. [PMID: 38527112 DOI: 10.1097/ncc.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Interactive features of computerized cognitive training (CCT) may enhance adherence to training, providing a relatively low-cost intervention. A robust systematic review on the effectiveness of CCT for improving working memory (WM) among pediatric survivors with cancer is lacking. OBJECTIVE To summarize the available evidence and determine the effectiveness of CCT for WM among pediatric survivors with cancer. INTERVENTIONS/METHODS Five databases were searched. The Effective Public Health Practice Project was used to assess the study quality. ReviewerManager was used. The primary outcome was WM performance. Secondary outcomes included processing speed, attention, intervention adherence, and number of adverse events. RESULTS Six studies were included. Regarding overall quality, 1 study was weak, and 5 studies were moderate. Five studies reported a significant improvement of WM postintervention (P < .05). The meta-analysis of Cogmed interventions on symbolic WM revealed a significant difference between groups (vs placebo), with an overall pooled effect size of 0.71 (95% confidence interval, 0.02-1.41; P = .04). Two and 4 studies investigated the effects of CCT on processing speed and attention, respectively, with conflicting results. Four studies reported adherence of 80% or greater. Two studies reported no adverse events. CONCLUSIONS Computerized cognitive training using Cogmed has a significant positive effect on WM. The effects of CCT on processing speed and attention remain inconclusive. IMPLICATIONS FOR PRACTICE More rigorous trials should be conducted to elucidate the cognitive effects of CCT, particularly processing speed and attention, in the pediatric population with cancer. Further studies should consider combining CCT with other existing interventions to strengthen their effectiveness.
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Affiliation(s)
- Katherine K W Lam
- Author Affiliations: School of Nursing, Hong Kong Polytechnic University (Drs Lam, Ho, Hammoda, and Yuen; Mss Liu and Yang; and Messrs Ng, Lam, and Belay); and Hong Kong Children's Hospital (Drs Liu and Chan)
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Iacono D, Hatch K, Murphy EK, Post J, Cole RN, Perl DP, Day RM. Proteomic changes in the hippocampus of large mammals after total-body low dose radiation. PLoS One 2024; 19:e0296903. [PMID: 38427613 PMCID: PMC10906861 DOI: 10.1371/journal.pone.0296903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/19/2023] [Indexed: 03/03/2024] Open
Abstract
There is a growing interest in low dose radiation (LDR) to counteract neurodegeneration. However, LDR effects on normal brain have not been completely explored yet. Recent analyses showed that LDR exposure to normal brain tissue causes expression level changes of different proteins including neurodegeneration-associated proteins. We assessed the proteomic changes occurring in radiated vs. sham normal swine brains. Due to its involvement in various neurodegenerative processes, including those associated with cognitive changes after high dose radiation exposure, we focused on the hippocampus first. We observed significant proteomic changes in the hippocampus of radiated vs. sham swine after LDR (1.79Gy). Mass spectrometry results showed 190 up-regulated and 120 down-regulated proteins after LDR. Western blotting analyses confirmed increased levels of TPM1, TPM4, PCP4 and NPY (all proteins decreased in various neurodegenerative processes, with NPY and PCP4 known to be neuroprotective) in radiated vs. sham swine. These data support the use of LDR as a potential beneficial tool to interfere with neurodegenerative processes and perhaps other brain-related disorders, including behavioral disorders.
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Affiliation(s)
- Diego Iacono
- DoD/USU Brain Tissue Repository & Neuropathology Program, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- Neuroscience Program, Department of Anatomy, Physiology and Genetics (APG), F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, Maryland, United States of America
- Neurodegeneration Disorders Clinic, National Institute of Neurological Disorders and Stroke, NINDS, NIH, Bethesda, Maryland, United States of America
| | - Kathleen Hatch
- DoD/USU Brain Tissue Repository & Neuropathology Program, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, Maryland, United States of America
| | - Erin K. Murphy
- DoD/USU Brain Tissue Repository & Neuropathology Program, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, Maryland, United States of America
| | - Jeremy Post
- Mass Spectrometry and Proteomics, Department of Biological Chemistry, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America
| | - Robert N. Cole
- Mass Spectrometry and Proteomics, Department of Biological Chemistry, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America
| | - Daniel P. Perl
- DoD/USU Brain Tissue Repository & Neuropathology Program, Uniformed Services University (USU), Bethesda, Maryland, United States of America
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, United States of America
| | - Regina M. Day
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University (USU), Bethesda, Maryland, United States of America
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Söderström H, Walfridsson A, Martinsson U, Isacsson U, Brocki K, Kleberg JL, Ljungman G. Neurocognition and mean radiotherapy dose to vulnerable brain structures: new organs at risk? Radiat Oncol 2023; 18:132. [PMID: 37568180 PMCID: PMC10416465 DOI: 10.1186/s13014-023-02324-2] [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: 06/27/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Children with brain tumors are at high risk of neurocognitive decline after radiotherapy (RT). However, there is a lack of studies on how RT doses to organs at risk (OARs) impacts neurocognition. The aim of this study was to examine dose-risk relationships for mean RT dose to different brain structures important for neurocognitive networks. We explored previously established OARs and potentially new OARs. METHODS A sample of 44 pediatric brain tumor survivors who had received proton and/or photon RT were included. Correlations between mean RT doses to OARs and IQ were analyzed. Previously established OARs were cochleae, optic chiasm, optic nerve, pituitary gland, hypothalamus, hippocampus and pons. Potential new OARs for RT-induced neurocognitive decline were cerebellum, vermis and thalamus. RESULTS Mean RT dose to different OARs correlated with several IQ subtests. Higher mean RT dose to cochleae, optic nerve, cerebellum, vermis and pons was correlated with lower performance on particularly full-scale IQ (FIQ), Perceptual Reasoning (PRI), Working Memory (WMI) and Processing Speed Index (PSI). Higher mean RT dose to hippocampus correlated with lower performance on processing speed and working memory. For those receiving whole brain RT (WBRT), higher mean RT dose to the pituitary gland correlated with lower performance on working memory. CONCLUSION A high dose-risk correlation was found between IQ subtests and mean RT dose in established and potential new OARs. Thus, in the lack of validated dose constraints for vulnerable brain structures, a parsimonious approach in RT planning should be considered to preserve neurocognitive networks.
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Affiliation(s)
- Helena Söderström
- Present Address: Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Angelica Walfridsson
- Department of Hematology and Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Ulla Martinsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ulf Isacsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Karin Brocki
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Johan Lundin Kleberg
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Ljungman
- Present Address: Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Lassaletta Á, Morales JS, Valenzuela PL, Esteso B, Kahalley LS, Mabbott DJ, Unnikrishnan S, Panizo E, Calvo F. Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis. World J Pediatr 2023; 19:727-740. [PMID: 37154861 PMCID: PMC10348930 DOI: 10.1007/s12519-023-00726-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT). METHODS A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies. RESULTS Totally 10 studies (n = 630 patients, average age range: 1-20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29-0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention. CONCLUSIONS Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results.
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Affiliation(s)
- Álvaro Lassaletta
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain.
- Pediatric Neuro-Oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Javier S Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
- Systems Biology Department, University of Alcalá, Madrid, Spain
| | - Borja Esteso
- Clinical Neuropsychology Unit, Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lisa S Kahalley
- Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Donald J Mabbott
- The Hospital for Sick Children, Toronto, ON, Canada
- The University of Toronto, Toronto, ON, Canada
| | | | - Elena Panizo
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain
| | - Felipe Calvo
- Radiation Oncology Department, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta 1, 28027, Madrid, Spain
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Fraley CE, Neiman JS, Feddersen CR, James C, Jones TG, Mikkelsen M, Nuss R, Schlenz AM, Winters AC, Green AL, Compas BE. Identifying patterns of neurocognitive dysfunction through direct comparison of children with leukemia, central nervous system tumors, and sickle cell disease. Pediatr Blood Cancer 2023; 70:e30299. [PMID: 37036272 PMCID: PMC10546486 DOI: 10.1002/pbc.30299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To quantify and compare the magnitude and type of neurocognitive dysfunction in at-risk children with central nervous system (CNS) tumors, acute lymphoblastic leukemia (ALL), and sickle cell disease (SCD) using a common instrument and metric to directly compare these groups with each other. METHODS Fifty-three participants between the ages of 7 and 12 years (n = 27 ALL, n = 11 CNS tumor, n = 15 SCD) were enrolled and assessed using the NIH Toolbox Cognition Battery (NIHTCB). Participants with ALL or CNS tumor were 0-18 months posttherapy, while participants with SCD possessed the SS or Sβ0 genotype, took hydroxyurea, and had no known history of stroke. RESULTS Independent sample t-tests showed that participants with ALL and CNS tumor experienced greatest deficits in processing speed (ALL d = -0.96; CNS tumor d = -1.2) and inhibitory control and attention (ALL d = -0.53; CNS tumor d = -0.97) when compared with NIHTCB normative data. Participants with SCD experienced deficits in cognitive flexibility only (d = -0.53). Episodic memory was relatively spared in all groups (d = -0.03 to -0.32). There were no significant differences in function when groups were compared directly with each other by analysis of variance. CONCLUSIONS Use of a common metric to quantify the magnitude and type of neurocognitive dysfunction across at-risk groups of participants by disease shows that participants perform below age-expected norms in multiple domains and experience dysfunction differently than one another. This approach highlights patterns of dysfunction that can inform disease- and domain-specific interventions.
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Affiliation(s)
- Claire E Fraley
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jamie S Neiman
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charlotte R Feddersen
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Claire James
- Department of Biology, Carleton College, Northfield, Minnesota, USA
| | - Taylor G Jones
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Margit Mikkelsen
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alyssa M Schlenz
- Developmental Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amanda C Winters
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adam L Green
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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Boroun A, Gholamhosseinian H, Montazerabadi A, Molana SH, Pashaei F. Optimizing the Radiation Treatment Planning of Brain Tumors by Integration of Functional MRI and White Matter Tractography. J Biomed Phys Eng 2023; 13:239-250. [PMID: 37312891 PMCID: PMC10258212 DOI: 10.31661/jbpe.v0i0.2210-1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2022] [Indexed: 06/15/2023]
Abstract
Background Diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) present the ability to selectively protect functional regions and fiber tracts of the brain when brain tumors are treated with radiotherapy. Objective This study aimed to assess whether the incorporation of fMRI and DTI data into the radiation treatment planning process of brain tumors could prevent the neurological parts of the brain from high doses of radiation. Material and Methods In this investigational theoretical study, the fMRI and DTI data were obtained from eight glioma patients. This patient-specific fMRI and DTI data were attained based on tumor location, the patient's general conditions, and the importance of the functional and fiber tract areas. The functional regions, fiber tracts, anatomical organs at risk, and the tumor were contoured for radiation treatment planning. Finally, the radiation treatment planning with and without fMRI & DTI information was obtained and compared. Results The mean dose to the functional areas and the maximum doses were reduced by 25.36% and 18.57% on fMRI & DTI plans compared with the anatomical plans. In addition, 15.59% and 20.84% reductions were achieved in the mean and maximum doses of the fiber tracts, respectively. Conclusion This study demonstrated the feasibility of using fMRI and DTI data in radiation treatment planning to maximize radiation protection of the functional cortex and fiber tracts. The mean and maximum doses significantly decreased to neurologically relevant brain regions, resulting in reducing the neuro-cognitive complications and improving the patient's quality of life.
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Affiliation(s)
- Arman Boroun
- Radiation Sciences Research Center (RSRC), Aja University of Medical Sciences, Tehran, Iran
| | | | - Alireza Montazerabadi
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hadi Molana
- Department of Radiation Oncology, Aja University of Medical Sciences, Tehran, Iran
| | - Fakhereh Pashaei
- Radiation Sciences Research Center (RSRC), Aja University of Medical Sciences, Tehran, Iran
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Rübe CE, Raid S, Palm J, Rübe C. Radiation-Induced Brain Injury: Age Dependency of Neurocognitive Dysfunction Following Radiotherapy. Cancers (Basel) 2023; 15:cancers15112999. [PMID: 37296960 DOI: 10.3390/cancers15112999] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Cranial radiotherapy is a known risk factor for neurocognitive impairment in cancer survivors. Although radiation-induced cognitive dysfunction is observed in patients of all ages, children seem to be more vulnerable than adults to suffering age-related deficits in neurocognitive skills. So far, the underlying mechanisms by which IR negatively influences brain functions as well as the reasons for the profound age dependency are still insufficiently known. We performed a comprehensive Pubmed-based literature search to identify original research articles that reported on age dependency of neurocognitive dysfunction following cranial IR exposure. Numerous clinical trials in childhood cancer survivors indicate that the severity of radiation-induced cognitive dysfunction is clearly dependent on age at IR exposure. These clinical findings were related to the current state of experimental research providing important insights into the age dependency of radiation-induced brain injury and the development of neurocognitive impairment. Research in pre-clinical rodent models demonstrates age-dependent effects of IR exposure on hippocampal neurogenesis, radiation-induced neurovascular damage and neuroinflammation.
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Affiliation(s)
- Claudia E Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
| | - Silvia Raid
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
| | - Jan Palm
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Kirrbergerstrasse Building 6.5, 66421 Homburg, Germany
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Sorokina SS, Paskevich SI, Zaichkina SI, Malkov AE, Pikalov VA. The Combined Effect of Protective Agents and Accelerated Carbon Ions on the Behavior of Mice. BIOL BULL+ 2022. [DOI: 10.1134/s1062359022120226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Rhodes A, Martin S, Toledo-Tamula MA, Loucas C, Glod J, Warren KE, Wolters PL. The neuropsychological profile of children with Diffuse Intrinsic Pontine Glioma (DIPG) before and after radiation therapy: A prospective longitudinal study. Child Neuropsychol 2022:1-25. [DOI: 10.1080/09297049.2022.2144189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amanda Rhodes
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Caitlyn Loucas
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Katherine E. Warren
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Department of Pediatric Neuro-Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, USA
| | - Pamela L. Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Region-Specific Effects of Fractionated Low-Dose Versus Single-Dose Radiation on Hippocampal Neurogenesis and Neuroinflammation. Cancers (Basel) 2022; 14:cancers14225477. [PMID: 36428572 PMCID: PMC9688466 DOI: 10.3390/cancers14225477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite technical advances in hippocampus-sparing radiotherapy, radiation-induced injury to neural stem cell compartments may affect neurocognitive functions. In pre-clinical mouse models with fractionated low-dose radiation (FLDR) and single-dose radiation (SDR), the accurate response to radiation-induced injury was analyzed in different hippocampal subregions. METHODS Adult and juvenile C57BL/6NCrl mice were exposed to FLDR (20 × 0.1 Gy, daily exposure from Monday to Friday for 4 weeks) or SDR (1 × 2 Gy). In addition, 72 h after the last exposure, neuroglia (astrocytes and microglia) and neuroprogenitor cells were characterized and quantified in the hippocampal cornu ammonis (CA) and dentate gyrus (DG) by immunofluorescence studies. RESULTS After analyzing different hippocampal subregions, it was observed that radiation responses varied between non-neurogenic CA, with no detectable inflammatory alterations, and neurogenic DG, characterized by impaired neurogenesis and subsequent neuroinflammation. Age-dependent differences in radiosensitivity appeared to depend on the varying proliferative potential of neural stem cell niches. Using the same overall dose for FLDR and SDR (2 Gy), both the cumulative dose over time and also the single dose fraction have decisive impacts on hippocampal damage. CONCLUSION Region-specific effects of radiation-induced hippocampal injury relies primarily on cell deaths of proliferating neuroprogenitors. Dose per fraction defines the extent of neuronal injury, and subsequently activated microglia and reactive astrocytes modulate dynamic processes of neuroinflammation. Thus, limiting both cumulative doses and dose fractions to hippocampal DG is an important issue of clinical radiotherapy to preserve neurocognitive functions.
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Huang J, Li H, Yan H, Li FX, Tang M, Lu DL. The comparative burden of brain and central nervous system cancers from 1990 to 2019 between China and the United States and predicting the future burden. Front Public Health 2022; 10:1018836. [PMID: 36339132 PMCID: PMC9635888 DOI: 10.3389/fpubh.2022.1018836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
Background Brain and central nervous system (CNS) cancers represent a major source of cancer burden in China and the United States. Comparing the two countries' epidemiological features for brain and CNS cancers can help plan interventions and draw lessons. Methods Data were extracted from the Global Burden of Disease repository. The average annual percentage change (AAPC) and relative risks of cancer burdens were calculated using joinpoint regression analysis and age-period-cohort (APC) models, respectively. Moreover, a Bayesian APC model was employed to predict the disease burden over the next decade. Results From 1990 to 2019, the number of incidences, deaths, and disability-adjusted life-years (DALYs) increased in China and the US, with a larger increase in China. Age-standardized incidence rates in China and the United States have shown an increasing trend over the past three decades, with AAPCs of 0.84 and 0.16%, respectively. However, the rates of age-standardized mortality and age-standardized DALYs decreased in both countries, with a greater decrease in China. Overall, age trends in cancer burden were similar for males and females, with two peaks in the childhood and elderly groups, respectively. The period and cohort effects on incidence showed an overall increasing trend in China and limited change in the US. However, the period effects for mortality and DALY were decreasing in both countries, while the cohort effects tended to increase and then decrease. Moreover, we predicted that the cancer burdens would continue to rise in China over the next decade. Conclusion The burden of brain and CNS cancers is substantial and will continue to increase in China. Comprehensive policy and control measures need to be implemented to reduce the burden.
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Les essais qui changent les pratiques : le point en 2022. Cancer Radiother 2022; 26:823-833. [DOI: 10.1016/j.canrad.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
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Neuroprotective effect of oxytocin on cognitive dysfunction, DNA damage, and intracellular chloride disturbance in young mice after cranial irradiation. Biochem Biophys Res Commun 2022; 612:1-7. [DOI: 10.1016/j.bbrc.2022.04.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
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Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review. Cancers (Basel) 2022; 14:cancers14112736. [PMID: 35681716 PMCID: PMC9179311 DOI: 10.3390/cancers14112736] [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: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Decline in cognitive function is a major problem for patients undergoing whole-brain radiotherapy (WBRT). Scientific interest has increased due to the high dropout rate of patients in the first months after WBRT and the early onset of cognitive decline. Therefore, the study of antiglutamatergic pharmacological prophylaxis and hippocampal-sparing WBRT techniques has been deepened based on the knowledge of the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline. In order to provide a summary of the evidence in this field, and to foster future research in this setting, this literature review presents current evidence on the prevention of radiation-induced cognitive decline and particularly on the role of memantine. Abstract Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects.
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Yeo KK, Alexandrescu S, Cotter JA, Vogelzang J, Bhave V, Li MM, Ji J, Benhamida JK, Rosenblum MK, Bale TA, Bouvier N, Kaneva K, Rosenberg T, Lim-Fat MJ, Ghosh H, Martinez M, Aguilera D, Smith A, Goldman S, Diamond EL, Gavrilovic I, MacDonald TJ, Wood MD, Nazemi KJ, Truong A, Cluster A, Ligon KL, Cole K, Bi WL, Margol AS, Karajannis MA, Wright KD. Multi-institutional study of the frequency, genomic landscape, and outcome of IDH-mutant glioma in pediatrics. Neuro Oncol 2022; 25:199-210. [PMID: 35604410 PMCID: PMC9825351 DOI: 10.1093/neuonc/noac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The incidence and biology of IDH1/2 mutations in pediatric gliomas are unclear. Notably, current treatment approaches by pediatric and adult providers vary significantly. We describe the frequency and clinical outcomes of IDH1/2-mutant gliomas in pediatrics. METHODS We performed a multi-institutional analysis of the frequency of pediatric IDH1/2-mutant gliomas, identified by next-generation sequencing (NGS). In parallel, we retrospectively reviewed pediatric IDH1/2-mutant gliomas, analyzing clinico-genomic features, treatment approaches, and outcomes. RESULTS Incidence: Among 851 patients with pediatric glioma who underwent NGS, we identified 78 with IDH1/2 mutations. Among patients 0-9 and 10-21 years old, 2/378 (0.5%) and 76/473 (16.1%) had IDH1/2-mutant tumors, respectively. Frequency of IDH mutations was similar between low-grade glioma (52/570, 9.1%) and high-grade glioma (25/277, 9.0%). Four tumors were graded as intermediate histologically, with one IDH1 mutation. Outcome: Seventy-six patients with IDH1/2-mutant glioma had outcome data available. Eighty-four percent of patients with low-grade glioma (LGG) were managed observantly without additional therapy. For low-grade astrocytoma, 5-year progression-free survival (PFS) was 42.9% (95%CI:20.3-63.8) and, despite excellent short-term overall survival (OS), numerous disease-related deaths after year 10 were reported. Patients with high-grade astrocytoma had a 5-year PFS/OS of 36.8% (95%CI:8.8-66.4) and 84% (95%CI:50.1-95.6), respectively. Patients with oligodendroglioma had excellent OS. CONCLUSIONS A subset of pediatric gliomas is driven by IDH1/2 mutations, with a higher rate among adolescents. The majority of patients underwent upfront observant management without adjuvant therapy. Findings suggest that the natural history of pediatric IDH1/2-mutant glioma may be similar to that of adults, though additional studies are needed.
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Affiliation(s)
- Kee Kiat Yeo
- Corresponding Author: Kee Kiat Yeo, MD, Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, 450 Brookline Ave, Boston, MA 02215, USA ()
| | | | | | - Jayne Vogelzang
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, MA, USA
| | | | - Marilyn M Li
- Division of Genomic Diagnostics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jianling Ji
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA,USA
| | - Jamal K Benhamida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejus A Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Bouvier
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristiyana Kaneva
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA,Tempus Labs, Inc., Chicago, IL, USA
| | - Tom Rosenberg
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Mary Jane Lim-Fat
- Department of Medical Oncology, Dana-Farber/Brigham and Women’s Hospital Cancer Center, Boston, MA, USA
| | - Hia Ghosh
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Migdalia Martinez
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Dolly Aguilera
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy Smith
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Stewart Goldman
- Department of Child Health, Phoenix Children’s Hospital, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Igor Gavrilovic
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tobey J MacDonald
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew D Wood
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kellie J Nazemi
- Department of Pediatrics, Doernbecher Children’s Hospital, Portland, OR, USA
| | - AiLien Truong
- Department of Pediatrics, Doernbecher Children’s Hospital, Portland, OR, USA
| | - Andrew Cluster
- Department of Pediatrics, St. Louis Children’s Hospital, St. Louis, MO, USA
| | - Keith L Ligon
- Department of Pathology, Dana-Farber/Brigham and Women’s Hospital Cancer Center, Boston, MA, USA
| | - Kristina Cole
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ashley S Margol
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Karen D Wright
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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Zhang S, Chen S, Ao P, Cai R, Liu W, Wei L. Polysaccharides from Laminaria japonica protect memory abilities and neurogenesis in mice after cranial irradiation through ameliorating neuroinflammation and collagen IV degradation. Int J Radiat Biol 2022; 98:1-10. [PMID: 35394414 DOI: 10.1080/09553002.2022.2063961] [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: 07/22/2021] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiation-induced brain injury (RIBI) is one of the most common long-term complications for patients with malignant brain tumors after radiotherapy. At present, there is no effective treatment for RIBI. Recent studies have also confirmed that polysaccharides from laminaria japonica (LJP) display potential neuroprotective function. However, its mechanisms of neuroprotection remain unclear. AIM In this study, we aimed to explore the effect and underlying mechanism of LJP on neurogenesis in radiation-induced brain injury mice. METHODS SPF two-month-old male mice were randomly divided into control group (Con), LJP treatment group (LJP), irradiation group (IR), and irradiation with LJP treatment group (IR + LJP). LJP (40 mg/kg/day) was intraperitoneally injected at one day before radiation for seven consecutive days (once daily). The mice were exposed to 10 Gy × 2 fractionated doses, once every other day, with a total dose of 20 Gy. Changes in cognitive function of mice following radiation were evaluated by the Morris water maze test. Furthermore, body weight and general status of mice were measured throughout the experiment. Immunohistochemical staining for neural proliferating cells (Ki67+ cells) and immature neurons (DCX + cells) was utilized to assay changes of neurogenesis in hippocampus. Microglial activation and collagen IV deposition within the neurogenic microenvironment were observed respectively by immunohistochemical staining for Iba-1 and Collagen IV in the hippocampus. Levels of pro-inflammatory cytokines (TNF-α and IL-1β) in the hippocampus were detected by ELISA kits post-radiation. RESULTS Morris water maze test showed that LJP therapy markedly reduced the escape latency and increased the times of crossing platform and percent time of the target quadrant in the radiated mice. In addition, the decrease of the neural proliferating cells (Ki67+ cells) and immature neurons (DCX + cells) in the hippocampus of mice following irradiation was significantly mitigated by the LJP treatment, suggesting that LJP could prevent from neurogenesis damage after irradiation. LJP injection significantly attenuated degradation of collagen IV, activation of microglia, and increase of pro-inflammatory cytokines (TNF-α and IL-1β) levels in the neurogenic microenvironment of the hippocampus after radiation. CONCLUSION These findings suggest that LJP early treatment may mitigate radiation-induced cognitive impairments and that its mechanism may relate to its protection of neurogenesis by alleviating neuroinflammation and collagen IV degradation within the neurogenic microenvironment.
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Affiliation(s)
- Siqin Zhang
- College of Stomatology, Guangxi Medical University, Guangxi Zhuang, Nanning, China
| | - Shaoyong Chen
- College of Stomatology, Guangxi Medical University, Guangxi Zhuang, Nanning, China
| | - Pian Ao
- College of Stomatology, Guangxi Medical University, Guangxi Zhuang, Nanning, China
| | - Rong Cai
- College of Stomatology, Guangxi Medical University, Guangxi Zhuang, Nanning, China
| | - Wenqi Liu
- Department of Radiation Oncology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Wei
- School of Basic Medical Sciences, Guangxi Medical University, Nanning, China
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18
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Voon NS, Manan HA, Yahya N. Diffusion tensor imaging indices as biomarkers for cognitive changes following paediatric radiotherapy: a systematic review and meta-analysis. Strahlenther Onkol 2022; 198:409-426. [PMID: 35238981 DOI: 10.1007/s00066-022-01905-6] [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: 10/13/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
Diffusion tensor imaging (DTI) can detect subtle manifestations of white matter (WM) injury following paediatric radiotherapy, which may be a potential biomarker for cognitive changes. This study aimed to synthesise the relationships between DTI indices and cognitive changes following paediatric radiotherapy through systematic review and meta-analysis. PubMed and Scopus electronic databases were used to identify eligible studies. Quality assessment was performed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information on demographics, DTI changes, and associations to cognitive outcomes were extracted. Meta-analyses were performed on DTI changes in specific anatomical locations. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the preparation of this report. Eighteen studies were included (median study size: 21; range 18-146). 17/18 studies showed significant cognitive decline following irradiation. Meta-analyses found significant cognitive changes within patient's group of acute lymphoblastic leukaemia (ALL; standard mean differences [SMD] = -0.075, P = 0.01) and brain tumours (BT; SMD = -1.037, P ≤ 0.001) compared to control/baseline. Both groups also had significantly lower fractional anisotropy (FA) scores in the corpus callosum (ALL: SMD = -0.979, P = 0.002; BT: SMD = -1.025, P < 0.001). Decreased FA was consistently associated with cognitive decline. Correlation on WMFA integrity to cognitive domains was statistically significant (Z = 9.86, P < 0.001) with a large effect size (r = 0.52). White matter tract integrity of the corpus callosum measured with FA has the potential to be a biomarker for radiotherapy-related cognitive decline. Inclusion of DTI in follow-up imaging should be encouraged.
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Affiliation(s)
- Noor Shatirah Voon
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, University Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia.
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Abuín-Porras V, Martinez-Perez C, Romero-Morales C, Cano-de-la-Cuerda R, Martín-Casas P, Palomo-López P, Sánchez-Tena MÁ. Citation Network Study on the Use of New Technologies in Neurorehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:26. [PMID: 35010288 PMCID: PMC8751120 DOI: 10.3390/ijerph19010026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
New technologies in neurorehabilitation is a wide concept that intends to find solutions for individual and collective needs through technical systems. Analysis through citation networks is used to search scientific literature related to a specific topic. On the one hand, the main countries, institutions, and authors researching this topic have been identified, as well as their evolution over time. On the other hand, the links between the authors, the countries, and the topics under research have been analyzed. The publications analysis was performed through the Web of Science database using the search terms "new technolog*," "neurorehabilitation," "physical therapy*," and "occupational therapy*." The selected interval of publication was from 1992 to December 2020. The results were analyzed using CitNetExplorer software. After a Web of Science search, a total of 454 publications and 135 citation networks were found, 1992 being the first year of publication. An exponential increase was detected from the year 2009. The largest number was detected in 2020. The main areas are rehabilitation and neurosciences and neurology. The most cited article was from Perry et al. in 2007, with a citation index of 460. The analysis of the top 20 most cited articles shows that most approach the use of robotic devices and brain-computer interface systems. In conclusion, the main theme was found to be the use of robotic devices to address neuromuscular rehabilitation goals and brain-computer interfaces and their applications in neurorehabilitation.
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Affiliation(s)
- Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Fundación DACER, Área de I+D+I, San Sebastián de los Reyes, 28702 Madrid, Spain
| | - Clara Martinez-Perez
- ISEC LISBOA—Instituto Superior de Educação e Ciências, 1750-179 Lisboa, Portugal; (C.M.-P.); (M.Á.S.-T.)
| | | | - Roberto Cano-de-la-Cuerda
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, IdISSC, 28040 Madrid, Spain;
| | | | - Miguel Ángel Sánchez-Tena
- ISEC LISBOA—Instituto Superior de Educação e Ciências, 1750-179 Lisboa, Portugal; (C.M.-P.); (M.Á.S.-T.)
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain
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20
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Ramírez-Guerrero S, Vargas-Cuellar MP, Charry-Sánchez JD, Talero-Gutiérrez C. Cognitive sequelae of radiotherapy in primary brain tumors. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Baroni LV, Freytes C, Fernández Ponce N, Oller A, Pinto N, Gonzalez A, Maldonado FR, Sampor C, Rugilo C, Lubieniecki F, Alderete D. Craniospinal irradiation as part of re-irradiation for children with recurrent medulloblastoma. J Neurooncol 2021; 155:53-61. [PMID: 34505229 DOI: 10.1007/s11060-021-03842-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies have demonstrated in the last years that once medulloblastoma has recurred, the probability of regaining tumor control is poor despite salvage therapy. Although re-irradiation has an emerging role in other relapsed brain tumors, there is a lack of strong data on re-irradiation for medulloblastoma. METHODS This is a retrospective cohort study of patients aged 18 years or under, treated at least by a second course of external beam for recurrence medulloblastoma at Garrahan Hospital between 2009 and 2020. Twenty-four patients met eligibility criteria for inclusion. All patients received upfront radiotherapy as part of the curative-intent first radiotherapy, either craniospinal irradiation (CSI) followed by posterior fossa boost in 20 patients or focal posterior fossa radiation in 4 infants. The second course of radiation consisted of CSI in 15 and focal in 9. The 3-year post first failure OS (50% vs. 0%; p = 0.0010) was significantly better for children who received re-CSI compared to children who received focal re-irradiation. Similarly, the 3-year post-re-RT PFS (31% vs. 0%; p = 0.0005) and OS (25% vs. 0%; p = 0.0003) was significantly improved for patients who received re-CSI compared to patients who received focal re-irradiation. No symptomatic intratumoral haemorrhagic events or symptomatic radionecrosis were observed. Survivors fell within mild to moderate intellectual disability range, with a median IQ at last assessment of 58 (range 43-69). CONCLUSIONS Re-irradiation with CSI is a safe and effective treatment for children with relapsed medulloblastoma; improves disease control and survival compared with focal re-irradiation. However this approach carries a high neurocognitive cost.
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Affiliation(s)
- Lorena V Baroni
- Service of Hematology/Oncology, Hospital JP Garrahan, Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina.
| | - Candela Freytes
- Service of Hematology/Oncology, Hospital JP Garrahan, Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
| | - Nicolás Fernández Ponce
- Service of Hematology/Oncology, Hospital JP Garrahan, Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
| | - Agustina Oller
- Service of Hematology/Oncology, Hospital JP Garrahan, Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
| | - Natalia Pinto
- Service of Radiotherapy, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Adriana Gonzalez
- Service of Interdisciplinary Clinic, Hospital JP Garrahan, Buenos Aires, Argentina
| | | | - Claudia Sampor
- Service of Hematology/Oncology, Hospital JP Garrahan, Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
| | - Carlos Rugilo
- Service of Diagnostic Imaging, Hospital JP Garrahan, Buenos Aires, Argentina
| | | | - Daniel Alderete
- Service of Hematology/Oncology, Hospital JP Garrahan, Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina.
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22
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Docking KM, Knijnik SR. Prospective longitudinal decline in cognitive-communication skills following treatment for childhood brain tumor. Brain Inj 2021; 35:1472-1479. [PMID: 34495783 DOI: 10.1080/02699052.2021.1970806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effect of childhood brain tumor and its treatments on the developing brain are recognized to cause late-occurring structural and functional changes, inclusive of neurocognitive and communication disturbances. AIMS The aim of the present study was to investigate changes in function in the prospective cognitive-communication and language abilities of two children surviving childhood brain tumor (CBT) over a 12-month period post-treatment. METHODS The comprehensive language and cognitive-communication abilities of two cases (male aged 7;8-8;8, female aged 10;9-11;9) were assessed at two timepoints over a 12-month period: six months and 18 months following completion of CBT cancer treatment. RESULTS Findings revealed a sharp decline in problem solving abilities over a 12-month period in the early stages of recovery from CBT in both cases examined, despite no or mild-moderate deficits in cognitive-communication or language function at initial assessment. Pre-literacy skills were noted to deteriorate on one task for one child, despite intact abilities at first assessment. CONCLUSIONS The findings of progressive deterioration of cognitive-communication skills in both children treated for CBT highlights a clear need for ongoing surveillance and full comprehensive assessment across development. The critical need for ongoing management after discharge and implementation of early intervention throughout development is highlighted.
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Affiliation(s)
- Kimberley M Docking
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stefani R Knijnik
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Child AE, Warren EA, Grosshans DR, Paulino AC, Okcu MF, Ris MD, Mahajan A, Orobio J, Cirino PT, Minard CG, Viana AG, Bick J, Woods SP, Chintagumpala M, Kahalley LS. Long-term cognitive and academic outcomes among pediatric brain tumor survivors treated with proton versus photon radiotherapy. Pediatr Blood Cancer 2021; 68:e29125. [PMID: 34114294 PMCID: PMC8316321 DOI: 10.1002/pbc.29125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Proton radiotherapy (PRT) may be associated with less neurocognitive risk than photon RT (XRT) for pediatric brain tumor survivors. We compared neurocognitive and academic outcomes in long-term survivors treated with XRT versus PRT. METHODS Survivors underwent neurocognitive evaluation >1 year after craniospinal (CSI) or focal PRT or XRT. Groups were compared using separate one-way analyses of covariance for the CSI and focal groups. RESULTS PRT (n = 58) and XRT (n = 30) subgroups were similar on gender (66% male), age at RT (median = 6.5 years), age at follow-up (median = 14.6 years), and government assistance status (32%). PRT and XRT focal groups differed on follow-up interval, shunt history, and total RT dose (all p < .05), whereas PRT and XRT CSI groups differed on follow-up interval, baseline neurocognitive performance score, boost volume, and CSI dose (all p < .05). The PRT focal group outperformed the XRT focal group on inhibition/switching (p = .04). The PRT CSI group outperformed the XRT CSI group on inattention/impulsivity (both p < .05). Several clinical variables (i.e., RT dose, boost field, baseline performance) predicted neurocognitive outcomes (all p < .05). The PRT focal group performed comparably to population means on most neurocognitive measures, while both CSI groups performed below expectation on multiple measures. The XRT CSI group was most impaired. All groups fell below expectation on processing speed, fine motor, and academic fluency (most p < .01). CONCLUSIONS Findings suggest generally favorable neurocognitive and academic long-term outcomes following focal PRT. Impairment was greatest following CSI regardless of modality. Dosimetry and baseline characteristics are important determinants of outcome alone or in combination with modality.
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Affiliation(s)
- Amanda E. Child
- Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore MD
| | - Emily A. Warren
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston TX
| | - David R. Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Arnold C. Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - M. Fatih Okcu
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston TX
| | - M. Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston TX
| | - Anita Mahajan
- Department of Radiation Oncology, The Mayo Clinic, Rochester MN
| | - Jessica Orobio
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas TX
| | | | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston TX
| | | | | | | | - Murali Chintagumpala
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston TX
| | - Lisa S. Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston TX
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24
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Yuen N, Szulc-Lerch KU, Li YQ, Morshead CM, Mabbott DJ, Wong CS, Nieman BJ. Metformin effects on brain development following cranial irradiation in a mouse model. Neuro Oncol 2021; 23:1523-1536. [PMID: 34042964 PMCID: PMC8408860 DOI: 10.1093/neuonc/noab131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cranial radiation therapy (CRT) is a mainstay of treatment for malignant pediatric brain tumors and high-risk leukemia. Although CRT improves survival, it has been shown to disrupt normal brain development and result in cognitive impairments in cancer survivors. Animal studies suggest that there is potential to promote brain recovery after injury using metformin. Our aim was to evaluate whether metformin can restore brain volume outcomes in a mouse model of CRT. METHODS C57BL/6J mice were irradiated with a whole-brain radiation dose of 7 Gy during infancy. Two weeks of metformin treatment started either on the day of or 3 days after irradiation. In vivo magnetic resonance imaging was performed prior to irradiation and at 3 subsequent time points to evaluate the effects of radiation and metformin on brain development. RESULTS Widespread volume loss in the irradiated brain appeared within 1 week of irradiation with limited subsequent recovery in volume outcomes. In many structures, metformin administration starting on the day of irradiation exacerbated radiation-induced injury, particularly in male mice. Metformin treatment starting 3 days after irradiation improved brain volume outcomes in subcortical regions, the olfactory bulbs, and structures of the brainstem and cerebellum. CONCLUSIONS Our results show that metformin treatment has the potential to improve neuroanatomical outcomes after CRT. However, both timing of metformin administration and subject sex affect structure outcomes, and metformin may also be deleterious. Our results highlight important considerations in determining the potential benefits of metformin treatment after CRT and emphasize the need for caution in repurposing metformin in clinical studies.
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Affiliation(s)
- Nili Yuen
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kamila U Szulc-Lerch
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yu-Qing Li
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cindi M Morshead
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Terrence Donelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario, Canada
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Donald J Mabbott
- Department of Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - C Shun Wong
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Nieman
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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25
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Miller KD, Ostrom QT, Kruchko C, Patil N, Tihan T, Cioffi G, Fuchs HE, Waite KA, Jemal A, Siegel RL, Barnholtz-Sloan JS. Brain and other central nervous system tumor statistics, 2021. CA Cancer J Clin 2021; 71:381-406. [PMID: 34427324 DOI: 10.3322/caac.21693] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
Brain and other central nervous system (CNS) tumors are among the most fatal cancers and account for substantial morbidity and mortality in the United States. Population-based data from the Central Brain Tumor Registry of the United States (a combined data set of the National Program of Cancer Registries [NPCR] and Surveillance, Epidemiology, and End Results [SEER] registries), NPCR, National Vital Statistics System and SEER program were analyzed to assess the contemporary burden of malignant and nonmalignant brain and other CNS tumors (hereafter brain) by histology, anatomic site, age, sex, and race/ethnicity. Malignant brain tumor incidence rates declined by 0.8% annually from 2008 to 2017 for all ages combined but increased 0.5% to 0.7% per year among children and adolescents. Malignant brain tumor incidence is highest in males and non-Hispanic White individuals, whereas the rates for nonmalignant tumors are highest in females and non-Hispanic Black individuals. Five-year relative survival for all malignant brain tumors combined increased between 1975 to 1977 and 2009 to 2015 from 23% to 36%, with larger gains among younger age groups. Less improvement among older age groups largely reflects a higher burden of glioblastoma, for which there have been few major advances in prevention, early detection, and treatment the past 4 decades. Specifically, 5-year glioblastoma survival only increased from 4% to 7% during the same time period. In addition, important survival disparities by race/ethnicity remain for childhood tumors, with the largest Black-White disparities for diffuse astrocytomas (75% vs 86% for patients diagnosed during 2009-2015) and embryonal tumors (59% vs 67%). Increased resources for the collection and reporting of timely consistent data are critical for advancing research to elucidate the causes of sex, age, and racial/ethnic differences in brain tumor occurrence, especially for rarer subtypes and among understudied populations.
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Affiliation(s)
- Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Nirav Patil
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- University Hospitals, Cleveland, Ohio
| | - Tarik Tihan
- Neuropathology Division, University of California, San Francisco, California
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland
| | - Hannah E Fuchs
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland
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26
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Schmal Z, Hammer B, Müller A, Rübe CE. Fractionated Low-Dose Radiation Induces Long-Lasting Inflammatory Responses in the Hippocampal Stem Cell Niche. Int J Radiat Oncol Biol Phys 2021; 111:1262-1275. [PMID: 34280471 DOI: 10.1016/j.ijrobp.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Despite major technical advances in hippocampus-sparing radiation therapy, radiation-induced injury to the neural stem cell compartment may affect neurocognitive functions. In the brain, glial cells modulate neuronal functions and are major mediators of neuroinflammation. In a preclinical mouse model with fractionated low-dose radiation (LDR), the complex response to radiation-induced injury was analyzed in the hippocampal stem cell compartment over a period of 6 months. METHODS AND MATERIALS Adult and juvenile C57BL/6NCrl mice were exposed to low doses of ionizing radiation (IR; 20 fractions of 0.1 Gy, for up to 4 weeks) daily. At 72 hours and 1, 3, and 6 months after fractionated LDR, magnetic resonance imaging (9.4 T) was conducted to detect structural and functional abnormalities in the hippocampal region. Using immunofluorescence and histologic studies, neuroglia cells (astrocytes, microglia, oligodendrocytes) were quantified and neuroinflammatory responses were characterized in the hippocampal dentate gyrus. Using in vivo bromodeoxyuridine labeling, the cell fate of newly generated progenitor cells was tracked in the subgranular zone of the dentate gyrus during fractionated LDR. RESULTS Low doses of IR induced long-lasting inflammatory responses with local increases of activated microglia and reactive astrocytes, which were most pronounced in the juvenile hippocampus within the first months after LDR. Glial activation with the consequent release of proinflammatory mediators increased local blood flow and vascular permeability in the hippocampal region. Cell fate mapping of progenitors located in the subgranular zone revealed a transient shift from neurogenesis to gliogenesis. CONCLUSIONS Glial cell activation and transient neuroinflammation may reflect radiation-induced neuronal damage in the hippocampal stem cell niche. The increased proliferative capacity of the developing brain may explain the enhanced hippocampal radiosensitivity, with stronger inflammatory reactions in the juvenile hippocampus. Thus, limiting the radiation dose to the hippocampal region is an important issue of clinical radiation therapy at all ages to preserve neurocognitive functions.
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Affiliation(s)
| | | | - Andreas Müller
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
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27
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Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma. J Pers Med 2021; 11:jpm11070661. [PMID: 34357128 PMCID: PMC8306901 DOI: 10.3390/jpm11070661] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022] Open
Abstract
Intracranial germinomas are rare tumours, usually affecting male paediatric patients. They frequently develop in the pineal and suprasellar regions, causing endocrinological disturbances, visual deficits, and increased intracranial pressure. The diagnosis is established on magnetic resonance imaging (MRI), serum and cerebrospinal fluid (CSF) markers, and tumour stereotactic biopsy. Imaging techniques, such as susceptibility-weighted imaging (SWI), T2* (T2-star) gradient echo (GRE) or arterial spin labelling based perfusion-weighted MRI (ASL-PWI) facilitate the diagnosis. Germinomas are highly radiosensitive tumours, with survival rates >90% in the context of chemoradiotherapy. However, patients with resistant disease have limited therapeutic options and poor survival. The aim of this review is to highlight the genetic, epigenetic, and immunologic features, which could provide the basis for targeted therapy. Intracranial germinomas present genetic and epigenetic alterations (chromosomal aberrations, KIT, MAPK and PI3K pathways mutations, DNA hypomethylation, miRNA dysregulation) that may represent targets for therapy. Tyrosine kinase and mTOR inhibitors warrant further investigation in these cases. Immune markers, PD-1 (programmed cell death protein 1) and PD-L1 (programmed death-ligand 1), are expressed in germinomas, representing potential targets for immune checkpoint inhibitors. Resistant cases should benefit from a personalized management: genetic and immunological testing and enrolment in trials evaluating targeted therapies in intracranial germinomas.
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28
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Liu KX, Lamba N, Marcus KJ, Sandler ES, Gold SH, Margolin JF, Haas-Kogan DA, Adams DM. Long-term outcomes of pediatric and young adult patients receiving radiotherapy for nonmalignant vascular anomalies. Pediatr Blood Cancer 2021; 68:e28955. [PMID: 33754454 DOI: 10.1002/pbc.28955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nonmalignant vascular anomalies (VA) comprise a heterogeneous spectrum of conditions characterized by aberrant growth or development of blood and/or lymphatic vessels and can cause significant morbidity. Little is known about outcomes after radiotherapy in pediatric and young adult patients with nonmalignant VA. METHODS Thirty patients who were diagnosed with nonmalignant VA and treated with radiotherapy prior to 2017 and before the age of 30 were identified. Clinical and treatment characteristics and outcomes were recorded. RESULTS Median age at first radiotherapy was 15 years (range 0.02-27). Median follow-up from completion of first radiotherapy was 9.8 years (range 0.02-67.4). Lymphatic malformations (33%), kaposiform hemangioendothelioma (17%), and venous malformations (17%) were the most common diagnoses. The most common indication for first radiotherapy was progression despite standard therapy and/or urgent palliation for symptoms (57%). After first radiotherapy, 14 patients (47%) had a complete response or partial response, defined as decrease in size of treated lesion or symptomatic improvement. After first radiotherapy, 27 (90%) required additional treatment for progression or recurrence. Long-term complications included telangiectasias, fibrosis, xerophthalmia, radiation pneumonitis, ovarian failure, and central hypothyroidism. No patient developed secondary malignancies. At last follow-up, three patients (10%) were without evidence of disease, 26 (87%) with disease, and one died of complications (3.3%). CONCLUSIONS A small group of pediatric and young adult patients with nonmalignant, high-risk VA experienced clinical benefit from radiotherapy with expected toxicity; however, most experienced progression. Prospective studies are needed to characterize indications for radiotherapy in VA refractory to medical therapy, including targeted inhibitors.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nayan Lamba
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric S Sandler
- Department of Pediatric Oncology, Nemours Children's Health Systems, Jacksonville, Florida, USA
| | - Stuart H Gold
- Division of Pediatric Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Judith F Margolin
- Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise M Adams
- Department of Hematology/Oncology, Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Recent Advances in Understanding the Role of Autophagy in Paediatric Brain Tumours. Diagnostics (Basel) 2021; 11:diagnostics11030481. [PMID: 33803216 PMCID: PMC8000899 DOI: 10.3390/diagnostics11030481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/21/2022] Open
Abstract
Autophagy is a degradative process occurring in eukaryotic cells to maintain homeostasis and cell survival. After stressful conditions including nutrient deprivation, hypoxia or drugs administration, autophagy is induced to counteract pathways that could lead to cell death. In cancer, autophagy plays a paradoxical role, acting both as tumour suppressor—by cleaning cells from damaged organelles and inhibiting inflammation or, alternatively, by promoting genomic stability and tumour adaptive response—or as a pro-survival mechanism to protect cells from stresses such as chemotherapy. Neural-derived paediatric solid tumours represent a variety of childhood cancers with unique anatomical location, cellular origins, and clinical presentation. These tumours are a leading cause of morbidity and mortality among children and new molecular diagnostics and therapies are necessary for longer survival and reduced morbidity. Here, we review advances in our understanding of how autophagy modulation exhibits antitumor properties in experimental models of paediatric brain tumours, i.e., medulloblastoma (MB), ependymoma (EPN), paediatric low-grade and high-grade gliomas (LGGs, HGGs), atypical teratoid/rhabdoid tumours (ATRTs), and retinoblastoma (RB). We also discuss clinical perspectives to consider how targeting autophagy may be relevant in these specific paediatric tumours.
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30
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Exercise Trials in Pediatric Brain Tumor: A Systematic Review of Randomized Studies. J Pediatr Hematol Oncol 2021; 43:59-67. [PMID: 32604333 DOI: 10.1097/mph.0000000000001844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/29/2020] [Indexed: 12/29/2022]
Abstract
In pediatric brain tumor patients, treatment advances have increased survival rates to nearly 70%, while consequently shifting the burden of disease to long-term management. Exercise has demonstrated potential in improving multiple health impairments secondary to brain tumor treatment. However, these effects have not been consolidated through review. Therefore, we performed a systematic review of 6 health sciences databases (Medline, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Central Database). Two reviewers screened studies against predefined inclusion criteria, namely that the study must: (i) be pediatric-specific; (ii) examine the effects of an exercise intervention; and (iii) employ a randomized or quasi-randomized trial design. The same 2 reviewers performed data extraction and analyses. From a pool of 4442, 5 articles-based on 2 independent trials-were included in our review (N=41). Exercise interventions were primarily aerobic, but included balance or muscle building components. Exercise had a positive effect on volumetric or diffusion-based neuroimaging outcomes, as well as motor performance and cardiorespiratory fitness. The effects of exercise on cognition remains unclear. Exercise did not worsen any of the outcomes studied. This review captures the state of the science, suggesting a potential role for exercise in children treated for brain tumor.
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31
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Xu Y, Sun Y, Zhou K, Xie C, Li T, Wang Y, Zhang Y, Rodriguez J, Zhang X, Shao R, Wang X, Zhu C. Cranial irradiation alters neuroinflammation and neural proliferation in the pituitary gland and induces late-onset hormone deficiency. J Cell Mol Med 2020; 24:14571-14582. [PMID: 33174363 PMCID: PMC7754041 DOI: 10.1111/jcmm.16086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/20/2022] Open
Abstract
Cranial radiotherapy induces endocrine disorders and reproductive abnormalities, particularly in long-term female cancer survivors, and this might in part be caused by injury to the pituitary gland, but the underlying mechanisms are unknown. The aim of this study was to investigate the influence of cranial irradiation on the pituitary gland and related endocrine function. Female Wistar rat pups on postnatal day 11 were subjected to a single dose of 6 Gy whole-head irradiation, and hormone levels and organ structure in the reproductive system were examined at 20 weeks after irradiation. We found that brain irradiation reduced cell proliferation and induced persistent inflammation in the pituitary gland. The whole transcriptome analysis of the pituitary gland revealed that apoptosis and inflammation-related pathways were up-regulated after irradiation. In addition, irradiation led to significantly decreased levels of the pituitary hormones, growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone and the reproductive hormones testosterone and progesterone. To conclude, brain radiation induces reduction of pituitary and reproduction-related hormone secretion, this may due to reduced cell proliferation and increased pituitary inflammation after irradiation. Our results thus provide additional insight into the molecular mechanisms underlying complications after head irradiation and contribute to the discovery of preventive and therapeutic strategies related to brain injury following irradiation.
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Affiliation(s)
- Yiran Xu
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Yanyan Sun
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Henan, China
| | - Kai Zhou
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, China
| | - Cuicui Xie
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Tao Li
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafeng Wang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaodong Zhang
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Rodriguez
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Xiaoan Zhang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruijin Shao
- Department of Physiology/Endocrinology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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32
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Raghuram N, Khan S, Mumal I, Bouffet E, Huang A. Embryonal tumors with multi-layered rosettes: a disease of dysregulated miRNAs. J Neurooncol 2020; 150:63-73. [PMID: 33090313 DOI: 10.1007/s11060-020-03633-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION ETMRs are highly lethal, pediatric embryonal brain tumors, previously classified as various histologic diagnoses including supratentorial primitive neuroectodermal tumors (sPNET) and CNS PNET. With recognition that these tumors harbor recurrent amplification of a novel oncogenic miRNA cluster on chr19, C19MC, ETMRs were designated as a distinct biological and molecular entity with a spectrum of histologic and clinical manifestations. METHODS We reviewed published literature describing clinical presentation, the genetic and epigenetic drivers of oncogenesis, and recent therapeutic strategies adopted to combat these aggressive tumors. RESULTS As a consequence of C19MC amplification, ETMRs upregulate several oncogenic and pluripotency proteins, including LIN28A, DNMT3B and MYCN, that confer a unique epigenetic signature reminiscent of nascent embryonic stem cells. In this review, we focus on the dysregulation of miRNAs in ETMR, the major pathogenic mechanism identified in this disease. CONCLUSION Despite the use of multi-modal therapeutic regimens, ETMR patients have dismal survival. Understanding the unique biology of these tumors has provided new insights towards novel therapeutic targets.
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Affiliation(s)
- Nikhil Raghuram
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada
| | - Sara Khan
- Monash Children's Cancer Centre, Monash Children's Hospital. Monash Health. Center for Cancer Research, Hudson Institute of Medical Research, and Department of Molecular and Translational Science, School of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, 3168, Australia.,Division of Hematology/Oncology, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON, M5G0A4, Canada
| | - Iqra Mumal
- Division of Hematology/Oncology, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON, M5G0A4, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, M5S1A8, Canada
| | - Eric Bouffet
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada
| | - Annie Huang
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada. .,Division of Hematology/Oncology, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON, M5G0A4, Canada. .,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, M5S1A8, Canada. .,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, M5G1L7, Canada.
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33
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Effects of Yoga-Based Interventions on Cancer-Associated Cognitive Decline: a Systematic Review. Curr Oncol Rep 2020; 22:100. [DOI: 10.1007/s11912-020-00960-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Neumann S, Porritt MJ, Osman AM, Kuhn HG. Cranial irradiation at early postnatal age impairs stroke-induced neural stem/progenitor cell response in the adult brain. Sci Rep 2020; 10:12369. [PMID: 32703986 PMCID: PMC7378832 DOI: 10.1038/s41598-020-69266-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/09/2020] [Indexed: 11/29/2022] Open
Abstract
Cranial irradiation (IR) is commonly used to treat primary brain tumors and metastatic diseases. However, cranial IR-treated patients often develop vascular abnormalities later in life that increase their risk for cerebral ischemia. Studies in rodents have demonstrated that IR impairs maintenance of the neural stem/precursor cell (NSPC) pool and depletes neurogenesis. We and others have previously shown that stroke triggers NSPC proliferation in the subventricular zone and migration towards the stroke-injured neocortex. Whether this response is sustained in the irradiated brain remains unknown. Here, we demonstrate that cranial IR in mice at an early postnatal age significantly reduced the number to neuronal progenitors responding to cortical stroke in adults. This was accompanied by a reduced number of microglia/macrophages in the peri-infarct cortex; however, the astrocytic response was not altered. Our findings indicate that IR impairs the endogenous repair capacity in the brain in response to stroke, hence pointing to another side effect of cranial radiotherapy which requires further attention.
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Affiliation(s)
- Susanne Neumann
- Department of Clinical Neuroscience, Institute for Neuroscience and Physiology, University of Gothenburg, Box 436, 405 30, Gothenburg, Sweden.,Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Michelle J Porritt
- Department of Clinical Neuroscience, Institute for Neuroscience and Physiology, University of Gothenburg, Box 436, 405 30, Gothenburg, Sweden
| | - Ahmed M Osman
- Department of Women's and Children's Health, Karolinska Institutet, 171 64, Stockholm, Sweden
| | - H Georg Kuhn
- Department of Clinical Neuroscience, Institute for Neuroscience and Physiology, University of Gothenburg, Box 436, 405 30, Gothenburg, Sweden.
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35
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Lu X, Zhang X, Deng X, Yang Z, Shen X, Sheng H, Yin B, Zhang N, Lin J. Incidence, Treatment, and Survival in Primary Central Nervous System Neuroblastoma. World Neurosurg 2020; 140:e61-e72. [PMID: 32344130 DOI: 10.1016/j.wneu.2020.04.145] [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: 01/16/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary central nervous system neuroblastoma (PCNSN) is a rare disease, and its incidence, treatment modalities, and survival remain poorly understood. METHODS The SEER (Surveillance Epidemiology and End Results) database was used to identify patients diagnosed with PCNSN from 1973 to 2013. The incidence and survival rates were examined. Clinical features, treatment modalities, and prognosis were also assessed. RESULTS A total of 280 patients with PCNSN were identified, with annual age-adjusted incidence being 0.37 per 1,000,000 persons in 1973 and decreasing to 0.12 in 2013. Neuroblastoma (NBL) (ganglioneuroblastoma vs. NBL; odds ratio [OR], 25.01; P = 0.008) and tumor with distant metastasis (OR, 0.17; P = 0.002) were more likely to receive conservative treatment over surgery, whereas older age (OR, 1.02; P = 0.011) and tumors located in the brain (other nervous system vs. brain: OR, 0.31; P = 0.001) increased the likelihood of receiving combined surgery and radiotherapy over surgery alone. In addition, younger age, ganglioneuroblastoma, and surgery treatment were significantly associated with improved outcomes (all P < 0.05). Furthermore, a nomogram model was established to effectively estimate survival for patients with PCNSN. CONCLUSIONS We updated epidemiologic information of PCNSN and showed that age, histologic type, tumor extension, and surgery were independent prognostic factors. Moreover, treatment modalities of these tumors are influenced by patient and tumor characteristics.
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Affiliation(s)
- Xiangqi Lu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaojia Zhang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangyang Deng
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zelin Yang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuchao Shen
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hansong Sheng
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nu Zhang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Lin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
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Mynarek M, von Hoff K, Pietsch T, Ottensmeier H, Warmuth-Metz M, Bison B, Pfister S, Korshunov A, Sharma T, Jaeger N, Ryzhova M, Zheludkova O, Golanov A, Rushing EJ, Hasselblatt M, Koch A, Schüller U, von Deimling A, Sahm F, Sill M, Riemenschneider MJ, Dohmen H, Monoranu CM, Sommer C, Staszewski O, Mawrin C, Schittenhelm J, Brück W, Filipski K, Hartmann C, Meinhardt M, Pietschmann K, Haberler C, Slavc I, Gerber NU, Grotzer M, Benesch M, Schlegel PG, Deinlein F, von Bueren AO, Friedrich C, Juhnke BO, Obrecht D, Fleischhack G, Kwiecien R, Faldum A, Kortmann RD, Kool M, Rutkowski S. Nonmetastatic Medulloblastoma of Early Childhood: Results From the Prospective Clinical Trial HIT-2000 and An Extended Validation Cohort. J Clin Oncol 2020; 38:2028-2040. [PMID: 32330099 DOI: 10.1200/jco.19.03057] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The HIT-2000-BIS4 trial aimed to avoid highly detrimental craniospinal irradiation (CSI) in children < 4 years of age with nonmetastatic medulloblastoma by systemic chemotherapy, intraventricular methotrexate, and risk-adapted local radiotherapy. PATIENTS AND METHODS From 2001-2011, 87 patients received systemic chemotherapy and intraventricular methotrexate. Until 2006, CSI was reserved for nonresponse or progression. After 2006, local radiotherapy was introduced for nonresponders or patients with classic medulloblastoma (CMB) or large-cell/anaplastic medulloblastoma (LCA). DNA methylation profiles of infantile sonic hedgehog-activated medulloblastoma (SHH-INF) were subdivided into iSHH-I and iSHH-II subtypes in the HIT-2000-BIS4 cohort and a validation cohort (n = 71) from the HIT group and Russia. RESULTS Five years after diagnosis, patients with desmoplastic medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN; n = 42) had 93% progression-free survival (5y-PFS), 100% overall survival (5y-OS), and 93% CSI-free (5y-CSI-free) survival. Patients with CMB/LCA (n = 45) had 37% 5y-PFS, 62% 5y-OS, and 39% 5y-CSI-free survival. Local radiotherapy did not improve survival in patients with CMB/LCA. All DMB/MBEN assessed by DNA methylation profiling belonged to the SHH-INF subgroup. Group 3 patients (5y-PFS, 36%; n = 14) relapsed more frequently than the SHH-INF group (5y-PFS, 93%; n = 28) or group 4 patients (5y-PFS, 83%; n = 6; P < .001). SHH-INF split into iSHH-I and iSHH-II subtypes in HIT-2000-BIS4 and the validation cohort, without prognostic impact (5y-PFS: iSHH-I, 73%, v iSHH-II, 83%; P = .25; n = 99). Intelligence quotient (IQ) was significantly lower in patients after CSI (mean IQ, 90 [no radiotherapy], v 74 [CSI]; P = .012). CONCLUSION Systemic chemotherapy and intraventricular methotrexate led to favorable survival in both iSHH subtypes of SHH-activated DMB/MBEN with acceptable neurotoxicity. Survival in patients with non-wingless (WNT)/non-SHH disease with CMB/LCA was not improved by local radiotherapy. Patients with group 4 disease had more favorable survival rates than those with group 3 medulloblastoma.
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Affiliation(s)
- Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Charite - University Medical Center Berlin, Berlin, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy, University of Bonn, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Holger Ottensmeier
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefan Pfister
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center; and Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tanvi Sharma
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Natalie Jaeger
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Marina Ryzhova
- Department of Neuropathology, N. N. Burdenko Neurosurgical Institute, Moscow, Russia
| | - Olga Zheludkova
- Department of Pediatric Oncology, Russian Scientific Center of Roentgenoradiology, Moscow, Russia
| | - Andrey Golanov
- Department of Stereotactic Radiotherapy and Radiosurgery, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | | | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Muenster, Muenster, Germany
| | - Arend Koch
- Department of Neuropathology, Charite - University Medical Center Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neuropathology, University Medical Center Hamburg-Eppendorf; and Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center; and Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center; and Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | | | - Hildegard Dohmen
- Institute for Neuropathology, University Hospital Gießen and Marburg, Gießen, Germany
| | - Camelia Maria Monoranu
- Institute of Pathology, Department of Neuropathology, University of Wuerzburg; and Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany
| | - Clemens Sommer
- Institute for Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ori Staszewski
- Institute of Neuropathology and Berta-Ottenstein-Programme for Advanced Clinician Scientists, University of Freiburg, Freiburg, Germany
| | - Christian Mawrin
- Institute for Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute for Pathology and Neuropathology, University Medical Center Tuebingen, Tuebingen, Germany
| | - Wolfgang Brück
- Institute for Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Katharina Filipski
- Institute of Neurology (Edinger Institute), University Hospital, Frankfurt Am Main; German Cancer Consortium, Partner Site Frankfurt/Mainz; and German Cancer Research Center, Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Matthias Meinhardt
- Institute for Pathology, University Medical Center Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Christine Haberler
- Institute of Neurology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicolas U Gerber
- Department of Oncology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Michael Grotzer
- Department of Oncology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Paul Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - Frank Deinlein
- Department of Pediatric Hematology and Oncology, University Children's Hospital Wuerzburg, Wuerzburg, Germany
| | - André O von Bueren
- Department of Pediatrics, Obstetrics and Gynecology, Division of Pediatric Hematology and Oncology, University Hospital of Geneva; and Department of Pediatrics, CANSEARCH Research Laboratory, University of Geneva, Geneva, Switzerland
| | - Carsten Friedrich
- Division of Pediatric Oncology and Hematology, University Children's Hospital Rostock, Rostock, Germany
| | - Björn-Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Fleischhack
- Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | | | - Marcel Kool
- Hopp Children's Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Division of Pediatric Neurooncology (B062), German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Dosimetric comparison between intensity-modulated radiotherapy and volumetric-modulated arc therapy in hippocampus sparing in brain metastasis treated by whole-brain irradiation and simultaneous integrated boost. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:While treating brain metastasis with whole-brain radiotherapy incorporating a simultaneous integrated boost (WBRT-SIB), the risk of hippocampus injury is high. The aim of this study is to compare dosimetrically between intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in sparing of hippocampus and organs at risk (OARs) and planning target volume (PTV) coverage.Methods:In total, 16 patients presenting with more than one brain metastases were previously treated and then retrospectively planned using VMAT and IMRT techniques. For each patient, a dual-arc VMAT and another IMRT (five beams) plans were created. For both techniques, 30 Gy in 10 fractions was prescribed to the whole brain (WB) minus the hippocampi and 45 Gy in 10 fractions to the tumour with 0·5 cm margin. Dose–volume histogram (DVH), conformity index (CI) and homogeneity index (HI) of PTV, hippocampus mean and maximum dose and other OARs for both techniques were calculated and compared.Results:A statistically significant advantage was found in WB-PTV CI and HI with VMAT, compared to IMRT. There were lower hippocampus mean and maximum doses in VMAT than IMRT. The maximum hippocampus dose ranged between 15·5 and 19·2 Gy and between 18·4 and 20·6 Gy in VMAT and IMRT, respectively. The mean dose of the hippocampus ranged between 11·5 and 17·7 Gy and between 13·2 and 18·3 Gy in VMAT and IMRT, respectively.Conclusion:Using WBRT-SIB technique, VMAT showed better PTV coverage with less mean and maximum doses to the hippocampus than IMRT. Clinical randomised studies are needed to confirm safety and clinical benefit of WBRT-SIB.
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Assessment of out-of-field doses in radiotherapy treatments of paediatric patients using Monte Carlo methods and measurements. Phys Med 2020; 71:53-61. [DOI: 10.1016/j.ejmp.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/18/2019] [Accepted: 02/13/2020] [Indexed: 01/22/2023] Open
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Pasqual E, Bosch de Basea M, López-Vicente M, Thierry-Chef I, Cardis E. Neurodevelopmental effects of low dose ionizing radiation exposure: A systematic review of the epidemiological evidence. ENVIRONMENT INTERNATIONAL 2020; 136:105371. [PMID: 32007921 DOI: 10.1016/j.envint.2019.105371] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The neurodevelopmental effects of high doses of ionizing radiation (IR) in children are well established. To what extent such effects exist at low-to-moderate doses is unclear. Considering the increasing exposure of the general population to low-to-moderate levels of IR, predominantly from diagnostic procedures, the study of these effects has become a priority for radiation protection. OBJECTIVES We conducted a systematic review of the current evidence for possible effects of low-to-moderate IR doses received during gestation, childhood and adolescence on different domains of neurodevelopment. DATA SOURCES Searches were performed in PubMed, Scopus, EMBASE and Psychinfo on the 6th of June 2017 and repeated in December 2018. STUDY ELIGIBILITY CRITERIA We included studies evaluating the association between low-to-moderate IR doses received during gestation, childhood and adolescence, and neurodevelopmental functions. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were evaluated using the Cochrane Collaboration's risk of bias tool adapted to environmental sciences. A qualitative synthesis was performed. RESULTS A total of 26 manuscripts were finally selected. Populations analyzed in these publications were exposed to the following sources of IR: atomic bomb (Hiroshima and Nagasaki), diagnostic/therapeutic radiation, and Chernobyl and nuclear weapon testing fallout. There was limited evidence for an association between low-to-moderate doses of IR and a decrease in general cognition and language abilities, that is, a causal interpretation is credible, but chance or confounding cannot not be ruled out with reasonable confidence. Evidence for a possible stronger effect when exposure occurred early in life, in particular, during the fetal period, was inadequate. Evidence for an association between IR and other specific domains, including attention, executive function, memory, processing speed, visual-spatial abilities, motor and socio-emotional development, was inadequate, due to the very limited number of studies found. LIMITATIONS, CONCLUSIONS, AND IMPLICATIONS OF KEY FINDINGS Overall, depending on the domain, there was limited to inadequate evidence for an effect of low-to-moderate IR doses on neurodevelopment. Heterogeneity across studies in terms of outcome and exposure assessment hampered any quantitative synthesis and any stronger conclusion. Future research with adequate dosimetry and covering a range of specific neurodevelopmental outcomes would likely contribute to improve the body of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER The systematic review protocol was registered in PROSPERO (registration number CRD42018091902).
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Affiliation(s)
- Elisa Pasqual
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Magda Bosch de Basea
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mónica López-Vicente
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Wang Z, Zhong XL, Xu Y, He J, Liu ZH, Nai AT, Niu L, Luo SS, Yang H, Zeng JY, He SY, Chen X, Wan W, Cao WY. Irradiation increases brain-derived neurotrophic factor precursor signaling in the mouse hippocampus. Neurobiol Learn Mem 2020; 171:107186. [PMID: 32084558 DOI: 10.1016/j.nlm.2020.107186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Zhen Wang
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China
| | - Xiao Lin Zhong
- Institute of Clinical Medicine, The First Affiliated Hospital of University of South China, 421001 Hengyang, Hunan, China
| | - Yang Xu
- Institute of Neuroscience, Medical College, University of South China, 421001 Hengyang, Hunan, China
| | - Jie He
- Department of Pathology, Medical College, University of South China, 421001 Hengyang, Hunan, China
| | - Zheng Hai Liu
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China
| | - Ai Tao Nai
- Department of Radiation Oncology, The First Affiliated Hospital of University of South China, 421001 Hengyang, Hunan, China
| | - Lei Niu
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China
| | - Shi Shi Luo
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China
| | - Hui Yang
- Department of Pathology, Medical College, University of South China, 421001 Hengyang, Hunan, China
| | - Jia Yu Zeng
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China
| | - Shu Ya He
- School of Public Health, University of South China, 421001 Hengyang, Hunan, China
| | - Xi Chen
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China
| | - Wei Wan
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China; Key Laboratory of Brain Science Research & Transformation In Tropical Environment of Hainan Province, Hainan Medical University, 571199 Haikou, China.
| | - Wen Yu Cao
- Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, 421001 Hengyang, Hunan, China.
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Temporal lobe sparing radiotherapy with photons or protons for cognitive function preservation in paediatric craniopharyngioma. Radiother Oncol 2020; 142:140-146. [DOI: 10.1016/j.radonc.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
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Gummersall T, Skaczkowski G, Wilson C. Childhood cancer, age at diagnosis and educational attainment: A meta-analysis. Crit Rev Oncol Hematol 2020; 145:102838. [DOI: 10.1016/j.critrevonc.2019.102838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
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Yeo KK, Kayser K, Margol AS, Wong KK, Robison N, Finlay J, Dhall G. Clinical and neuropsychological outcome of pediatric non-midline central nervous system germinoma treated with chemotherapy and reduced dose/volume irradiation: The Children's Hospital Los Angeles experience. Pediatr Blood Cancer 2019; 66:e27983. [PMID: 31502379 DOI: 10.1002/pbc.27983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Germ cell tumors (GCT) arising from non-midline structures (basal ganglia, thalamus, and posterior fossa) are rare. Although patients with midline (pineal and suprasellar) germinoma have excellent survival with chemotherapy and whole ventricular irradiation (WVI), germinoma in non-midline locations have traditionally been treated with craniospinal irradiation (CSI) or whole brain irradiation (WBI) to achieve similar outcomes. However, CSI and WBI are associated with significant long-term neuropsychological sequelae. METHODS We describe the clinical and neuropsychological outcomes of patients with non-midline germinoma treated at the Children's Hospital Los Angeles between 1990 and 2015. RESULTS Nine patients had basal ganglia/thalamic germinoma and one patient had a cerebellar primary. Eight patients received chemotherapy followed by reduced dose/volume irradiation, whereas two patients received chemotherapy alone as upfront therapy. One patient in the chemotherapy alone group relapsed after 4.3 years and was salvaged with CSI plus boost. The overall survival for the entire cohort was 100% at a median follow-up of 8.5 years. Neuropsychological data were available for six patients at a median of five months (baseline) and 4.2 years (follow-up) post-diagnosis. At four-year follow-up, data available revealed intact overall cognitive ability, verbal memory, and executive functioning, but persistent deficits in fine motor function. Comparison of baseline to follow-up suggests a downward trend in working memory, planning/problem-solving, verbal memory, and visuospatial integration. CONCLUSION Chemotherapy followed by reduced dose/volume of irradiation is an effective strategy resulting in long-term survival in patients with non-midline germinoma. Neuropsychological data suggest relatively minimal morbidity over time.
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Affiliation(s)
- Kee Kiat Yeo
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Kimberly Kayser
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley S Margol
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth K Wong
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California.,University of Southern California, Department of Radiation Oncology, Los Angeles, California
| | - Nathan Robison
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan Finlay
- The Neuro-oncology Program, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California.,The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, University of Alabama at Birmingham (UAB), Birmingham, Alabama
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Gauvreau S, Lefebvre J, Bells S, Laughlin S, Bouffet E, Mabbott DJ. Disrupted network connectivity in pediatric brain tumor survivors is a signature of injury. J Comp Neurol 2019; 527:2896-2909. [PMID: 31125446 DOI: 10.1002/cne.24717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 11/12/2022]
Abstract
Cognition is compromised in pediatric brain tumor survivors but the neurophysiological basis of this compromise remains unclear. We hypothesized that reduced neural synchronization across brain networks is involved. To test this, we evaluated group differences using a retrospective cohort comparison design between 24 pediatric brain tumor survivors [11.81 ± 3.27)] and 24 age matched healthy children [12.04 ± 3.28)] in functional connectivity within a cerebellar network to examine local effects of the tumor, a whole brain network to examine diffuse effects of treatment (i.e., chemotherapy and radiation), and across multiple intrinsic connectivity networks. Neural activity was recorded during magnetoencephalography scanning while participants were at rest and functional connectivity within networks was measured using the phase lag index. We corroborated our findings using a computational model representing the local tumor effects on neural synchrony. Compared to healthy children, pediatric brain tumor survivors show increased functional connectivity for theta and beta frequency bands within the cerebellar network and increased functional connectivity for the theta band within the whole brain network that again localized to the cerebellum. Computational modeling showed that increased synchrony in the theta bad is observed following local clustering as well as sparse interarea brain connectivity. We also observed increased functional connectivity for the alpha frequency band in the ventral attention network and decreased functional connectivity within the gamma frequency band in the motor network within paedatric brain tumor survivors versus healthy children. Notably, increased gamma functional connectivity within the motor network predicted decreased reaction time on behavioral tasks in pediatric brain tumor survivors. Disrupted network synchrony may be a signature of neurological injury and disease.
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Affiliation(s)
- Samantha Gauvreau
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| | - Jérémie Lefebvre
- Krembil Research Institute, University Health Network, Toronto, Canada.,Department of Mathematics, University of Toronto, Toronto, Canada
| | - Sonya Bells
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Suzanne Laughlin
- The Department of Diagnostic Imaging, Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,The Department of Medical Imaging, Medical Imaging, University of Toronto, Toronto, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Donald J Mabbott
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
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Yokota Y, Wada Y, Funayama T. Distinct modes of death in human neural stem and glioblastoma cells irradiated with carbon-ion radiation and gamma-rays. Int J Radiat Biol 2019; 96:172-178. [PMID: 31633435 DOI: 10.1080/09553002.2020.1683639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Accumulated damage in neural stem cells (NSCs) during brain tumor radiotherapy causes cognitive dysfunction to the patients. Carbon-ion radiotherapy can reduce undesired irradiation of normal tissues more efficiently than conventional photon radiotherapy. This study elucidates the responses of NSCs to carbon-ion radiation.Methods: Human NSCs and glioblastoma A-172 cells were irradiated with carbon-ion radiation and γ-rays, which have different linear-energy-transfer (LET) values of 108 and 0.2 keV/μm, respectively. After irradiation, growth rates were measured, apoptotic cells were detected by flow cytometry, and DNA synthesizing cells were immunocytochemically visualized.Results: Growth rates of NSCs and A-172 cells were decreased after irradiation. The percentages of apoptotic cells were remarkably increased in NSCs but not in A-172 cells. In contrast, the fractions of DNA synthesizing A-172 cells were decreased in a dose-dependent manner. These results indicate that apoptosis induction and DNA synthesis inhibition contribute to the growth inhibition of NSCs and glioblastoma cells, respectively. In addition, high-LET carbon ions induced more profound effects than low-LET γ-rays.Conclusions: Apoptosis is an important clinical target to protect NSCs during brain tumor radiotherapy using carbon-ion radiation as well as conventional X-rays.
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Affiliation(s)
- Yuichiro Yokota
- Department of Radiation-Applied Biology Research, Takasaki Advanced Radiation Research Institute, National Institutes for Quantum and Radiological Science and Technology, Takasaki, Japan
| | - Yutaka Wada
- Department of Radiation-Applied Biology Research, Takasaki Advanced Radiation Research Institute, National Institutes for Quantum and Radiological Science and Technology, Takasaki, Japan
| | - Tomoo Funayama
- Department of Radiation-Applied Biology Research, Takasaki Advanced Radiation Research Institute, National Institutes for Quantum and Radiological Science and Technology, Takasaki, Japan
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46
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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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47
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Medulloblastoma in childhood: What effects on neurocognitive functions? Cancer Radiother 2019; 23:370-377. [DOI: 10.1016/j.canrad.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
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48
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Michaelidesová A, Konířová J, Bartůněk P, Zíková M. Effects of Radiation Therapy on Neural Stem Cells. Genes (Basel) 2019; 10:E640. [PMID: 31450566 PMCID: PMC6770913 DOI: 10.3390/genes10090640] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 12/29/2022] Open
Abstract
Brain and nervous system cancers in children represent the second most common neoplasia after leukemia. Radiotherapy plays a significant role in cancer treatment; however, the use of such therapy is not without devastating side effects. The impact of radiation-induced damage to the brain is multifactorial, but the damage to neural stem cell populations seems to play a key role. The brain contains pools of regenerative neural stem cells that reside in specialized neurogenic niches and can generate new neurons. In this review, we describe the advances in radiotherapy techniques that protect neural stem cell compartments, and subsequently limit and prevent the occurrence and development of side effects. We also summarize the current knowledge about neural stem cells and the molecular mechanisms underlying changes in neural stem cell niches after brain radiotherapy. Strategies used to minimize radiation-related damages, as well as new challenges in the treatment of brain tumors are also discussed.
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Affiliation(s)
- Anna Michaelidesová
- Laboratory of Cell Differentiation, Institute of Molecular Genetics of the Czech Academy of Sciences, v. v. i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
- Department of Radiation Dosimentry, Nuclear Physics Institute of the Czech Academy of Sciences, v. v. i., Na Truhlářce 39/64, 180 00 Prague 8, Czech Republic
| | - Jana Konířová
- Laboratory of Cell Differentiation, Institute of Molecular Genetics of the Czech Academy of Sciences, v. v. i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
- Department of Radiation Dosimentry, Nuclear Physics Institute of the Czech Academy of Sciences, v. v. i., Na Truhlářce 39/64, 180 00 Prague 8, Czech Republic
| | - Petr Bartůněk
- Laboratory of Cell Differentiation, Institute of Molecular Genetics of the Czech Academy of Sciences, v. v. i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
| | - Martina Zíková
- Laboratory of Cell Differentiation, Institute of Molecular Genetics of the Czech Academy of Sciences, v. v. i., Vídeňská 1083, 142 20 Prague 4, Czech Republic.
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49
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DNA damage accumulation during fractionated low-dose radiation compromises hippocampal neurogenesis. Radiother Oncol 2019; 137:45-54. [DOI: 10.1016/j.radonc.2019.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 01/08/2023]
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50
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Moxon-Emre I, Farb NAS, Oyefiade AA, Bouffet E, Laughlin S, Skocic J, de Medeiros CB, Mabbott DJ. Facial emotion recognition in children treated for posterior fossa tumours and typically developing children: A divergence of predictors. NEUROIMAGE-CLINICAL 2019; 23:101886. [PMID: 31254938 PMCID: PMC6603305 DOI: 10.1016/j.nicl.2019.101886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
Facial emotion recognition (FER) deficits are evident and pervasive across neurodevelopmental, psychiatric, and acquired brain disorders in children, including children treated for brain tumours. Such deficits are thought to perpetuate challenges with social relationships and decrease quality of life. The present study combined eye-tracking, neuroimaging and cognitive assessments to evaluate if visual attention, brain structure, and general cognitive function contribute to FER in children treated for posterior fossa (PF) tumours (patients: n = 36) and typically developing children (controls: n = 18). To assess FER, all participants completed the Diagnostic Analysis of Nonverbal Accuracy (DANVA2), a computerized task that measures FER using photographs, while their eye-movements were recorded. Patients made more FER errors than controls (p < .01). Although we detected subtle deficits in visual attention and general cognitive function in patients, we found no associations with FER. Compared to controls, patients had evidence of white matter (WM) damage, (i.e., lower fractional anisotropy [FA] and higher radial diffusivity [RD]), in multiple regions throughout the brain (all p < .05), but not in specific WM tracts associated with FER. Despite the distributed WM differences between groups, WM predicted FER in controls only. In patients, factors associated with their disease and treatment predicted FER. Our study provides insight into predictors of FER that may be unique to children treated for PF tumours, and highlights a divergence in associations between brain structure and behavioural outcomes in clinical and typically developing populations; a concept that may be broadly applicable to other neurodevelopmental and clinical populations that experience FER deficits. Children treated for brain tumours have difficultly recognizing facial emotions. White matter predicts facial emotion recognition (FER) in typical development. Medical factors predict FER deficits in children treated for brain tumours. Brain-behaviour relations can diverge in the typical and atypical developing brain.
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Affiliation(s)
- Iska Moxon-Emre
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada; Pediatric Oncology Group of Ontario, Toronto, ON M5G 1V2, Canada
| | | | - Adeoye A Oyefiade
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Suzanne Laughlin
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Jovanka Skocic
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | | | - Donald J Mabbott
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; University of Toronto, Toronto, ON M5S 3G3, Canada.
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