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Franco D, Granata V, Fusco R, Grassi R, Nardone V, Lombardi L, Cappabianca S, Conforti R, Briganti F, Grassi R, Caranci F. Artificial intelligence and radiation effects on brain tissue in glioblastoma patient: preliminary data using a quantitative tool. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01655-0. [PMID: 37289266 DOI: 10.1007/s11547-023-01655-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE The quantification of radiotherapy (RT)-induced functional and morphological brain alterations is fundamental to guide therapeutic decisions in patients with brain tumors. The magnetic resonance imaging (MRI) allows to define structural RT-brain changes, but it is unable to evaluate early injuries and to objectively quantify the volume tissue loss. Artificial intelligence (AI) tools extract accurate measurements that permit an objective brain different region quantification. In this study, we assessed the consistency between an AI software (Quibim Precision® 2.9) and qualitative neruroradiologist evaluation, and its ability to quantify the brain tissue changes during RT treatment in patients with glioblastoma multiforme (GBM). METHODS GBM patients treated with RT and subjected to MRI assessment were enrolled. Each patient, pre- and post-RT, undergoes to a qualitative evaluation with global cerebral atrophy (GCA) and medial temporal lobe atrophy (MTA) and a quantitative assessment with Quibim Brain screening and hippocampal atrophy and asymmetry modules on 19 extracted brain structures features. RESULTS A statistically significant strong negative association between the percentage value of the left temporal lobe and the GCA score and the left temporal lobe and the MTA score was found, while a moderate negative association between the percentage value of the right hippocampus and the GCA score and the right hippocampus and the MTA score was assessed. A statistically significant strong positive association between the CSF percentage value and the GCA score and a moderate positive association between the CSF percentage value and the MTA score was found. Finally, quantitative feature values showed that the percentage value of the cerebro-spinal fluid (CSF) statistically differences between pre- and post-RT. CONCLUSIONS AI tools can support a correct evaluation of RT-induced brain injuries, allowing an objective and earlier assessment of the brain tissue modifications.
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Affiliation(s)
- Donatella Franco
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Vincenza Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | - Roberta Fusco
- Research & Development and Medical Oncology Division, Igea SpA, Naples, Italy
| | - Roberta Grassi
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy
| | - Valerio Nardone
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Laura Lombardi
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Renata Conforti
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Francesco Briganti
- Advanced Biomedical Sciences Department, Federico II University, Naples, Italy
| | - Roberto Grassi
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Ferdinando Caranci
- Division of Radiology, Department of Precision Medicine, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
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Lee HI, Kang MK, Hwang K, Kim CY, Kim YJ, Suh KJ, Choi BS, Choe G, Kim IA, Jang BS. Volumetric changes in gray matter after radiotherapy detected with longitudinal magnetic resonance imaging in glioma patients. Radiother Oncol 2022; 176:157-164. [PMID: 36208651 DOI: 10.1016/j.radonc.2022.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated volumetric changes in the gray matter (GM) after radiotherapy (RT) and identified factors that were strongly associated with GM volume reduction. MATERIALS AND METHODS A total of 461 magnetic resonance imagings (MRI) from 105 glioma patients treated with postoperative RT was retrospectively analyzed. Study patients' MRIs were collected at five time points: before RT and 1 month, 6 months, 1 year, and 2 years after RT. Using the 'FastSurfer' platform, a deep learning-based neuroimaging pipeline, 73 regions were automatically segmented from longitudinal MRIs and their volumetric changes were calculated. Regions were grouped into 10 functional fields. A multivariable linear mixed-effects model was established to identify the potential predictors of significant volume reduction. RESULTS The median age was 50 years (range, 16-86 years). Forty-seven (44.8 %) patients were female and 68 (64.8 %) had glioblastoma. Postoperative RT was delivered at 54-60 Gy with or without concurrent chemotherapy. At 2 years after RT, the median volumetric changes in the overall, ipsilateral, and contralateral GM were -3.5%, -4.5%, and -2.4%, respectively. The functional fields of cognition and execution of movement showed the greatest volume reductions. In the multivariable linear mixed model, female sex (normalized coefficient = -0.14, P < 0.001) and the interaction between age at RT and days after RT (normalized coefficient = -6.48e-6, P < 0.001) were significantly associated with GM reduction. The older patients received RT, the greater volume reduction was seen over time. However, in patients with relatively younger age (e.g., 45, 50, and 60 years for hippocampus, Broca area, and Wernicke area, respectively), the volume was not significantly reduced. CONCLUSIONS GM volume reduction was identified after RT that could lead to long-term treatment sequelae. Particularly for susceptible patients, individualized treatment and prevention strategies are needed.
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Affiliation(s)
- Hye In Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kang
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
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Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
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The impact of gamma-radiation on the cerebral- and cerebellar- cortex of male rats’ brain. Brain Res Bull 2022; 186:136-142. [DOI: 10.1016/j.brainresbull.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 01/22/2023]
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Schuermann M, Dzierma Y, Nuesken F, Oertel J, Rübe C, Melchior P. Automatic Radiotherapy Planning for Glioblastoma Radiotherapy With Sparing of the Hippocampus and nTMS-Defined Motor Cortex. Front Neurol 2022; 12:787140. [PMID: 35095732 PMCID: PMC8795623 DOI: 10.3389/fneur.2021.787140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundNavigated transcranial magnetic stimulation (nTMS) of the motor cortex has been successfully implemented into radiotherapy planning by a number of studies. Furthermore, the hippocampus has been identified as a radiation-sensitive structure meriting particular sparing in radiotherapy. This study assesses the joint protection of these two eloquent brain regions for the treatment of glioblastoma (GBM), with particular emphasis on the use of automatic planning.Patients and MethodsPatients with motor-eloquent brain glioblastoma who underwent surgical resection after nTMS mapping of the motor cortex and adjuvant radiotherapy were retrospectively evaluated. The radiotherapy treatment plans were retrieved, and the nTMS-defined motor cortex and hippocampus contours were added. Four additional treatment plans were created for each patient: two manual plans aimed to reduce the dose to the motor cortex and hippocampus by manual inverse planning. The second pair of re-optimized plans was created by the Auto-Planning algorithm. The optimized plans were compared with the “Original” plan regarding plan quality, planning target volume (PTV) coverage, and sparing of organs at risk (OAR).ResultsA total of 50 plans were analyzed. All plans were clinically acceptable with no differences in the PTV coverage and plan quality metrics. The OARs were preserved in all plans; however, overall the sparing was significantly improved by Auto-Planning. Motor cortex protection was feasible and significant, amounting to a reduction in the mean dose by >6 Gy. The dose to the motor cortex outside the PTV was reduced by >12 Gy (mean dose) and >5 Gy (maximum dose). The hippocampi were significantly improved (reduction in mean dose: ipsilateral >6 Gy, contralateral >4.6 Gy; reduction in maximum dose: ipsilateral >5 Gy, contralateral >5 Gy). While the dose reduction using Auto-Planning was generally better than by manual optimization, the radiated total monitor units were significantly increased.ConclusionConsiderable dose sparing of the nTMS-motor cortex and hippocampus could be achieved with no disadvantages in plan quality. Auto-Planning could further contribute to better protection of OAR. Whether the improved dosimetric protection of functional areas can translate into improved quality of life and motor or cognitive performance of the patients can only be decided by future studies.
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Affiliation(s)
- Michaela Schuermann
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
- *Correspondence: Michaela Schuermann
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Frank Nuesken
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Joachim Oertel
- Faculty of Medicine, Saarland University, Saarbrücken, Germany
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Homburg, Germany
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Nagtegaal S, David S, van Grinsven E, van Zandvoort M, Seravalli E, Snijders T, Philippens M, Verhoeff J. Morphological changes after cranial fractionated photon radiotherapy: Localized loss of white matter and grey matter volume with increasing dose. Clin Transl Radiat Oncol 2021; 31:14-20. [PMID: 34504960 PMCID: PMC8416633 DOI: 10.1016/j.ctro.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/04/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Numerous brain MR imaging studies have been performed to understand radiation-induced cognitive decline. However, many of them focus on a single region of interest, e.g. cerebral cortex or hippocampus. In this study, we use deformation-based morphometry (DBM) and voxel-based morphometry (VBM) to measure the morphological changes in patients receiving fractionated photon RT, and relate these to the dose. Additionally, we study tissue specific volume changes in white matter (WM), grey matter (GM), cerebrospinal fluid and total intracranial volume (TIV). METHODS AND MATERIALS From our database, we selected 28 patients with MRI of high quality available at baseline and 1 year after RT. Scans were rigidly registered to each other, and to the planning CT and dose file. We used DBM to study non-tissue-specific volumetric changes, and VBM to study volume loss in grey matter. Observed changes were then related to the applied radiation dose (in EQD2). Additionally, brain tissue was segmented into WM, GM and cerebrospinal fluid, and changes in these volumes and TIV were tested. RESULTS Performing DBM resulted in clusters of dose-dependent volume loss 1 year after RT seen throughout the brain. Both WM and GM were affected; within the latter both cerebral cortex and subcortical nuclei show volume loss. Volume loss rates ranging from 5.3 to 15.3%/30 Gy were seen in the cerebral cortical regions in which more than 40% of voxels were affected. In VBM, similar loss rates were seen in the cortex and nuclei. The total volume of WM and GM significantly decreased with rates of 5.8% and 2.1%, while TIV remained unchanged as expected. CONCLUSIONS Radiotherapy is associated with dose-dependent intracranial morphological changes throughout the entire brain. Therefore, we will consider to revise sparing of organs at risk based on future cognitive and neurofunctional data.
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Key Words
- Brain neoplasms
- CAT12, Computational Anatomy Toolbox 12
- CSF, cerebrospinal fluid
- CT, computed tomography
- DBM, deformation based morphometry
- FWER, family-wise error rate
- GM, grey matter
- Gray matter
- IMPT, intensity modulated proton therapy
- MNI, Montreal Neurological Institute
- MRI, magnetic resonance imaging
- PALM, permutation analysis of linear models
- PTV, planning target volume
- RT, radiotherapy
- Radiotherapy
- SNR, signal to noise ratio
- TFCE, Threshold-Free Cluster Enhancement
- TFE, turbo fast echo
- TIV, total intracranial volume
- VBM, voxel-based morphometry
- VMAT, volumetric modulated arc therapy
- White matter
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Affiliation(s)
- S.H.J. Nagtegaal
- Department of Radiation Oncology, University Medical Center, HP Q 00.3.11, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - S David
- Department of Radiation Oncology, University Medical Center, HP Q 00.3.11, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - E.E. van Grinsven
- Department of Radiation Oncology, University Medical Center, HP Q 00.3.11, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - M.J.E. van Zandvoort
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center, HP L 01.310, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - E. Seravalli
- Department of Radiation Oncology, University Medical Center, HP Q 00.3.11, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - T.J Snijders
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center, HP L 01.310, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - M.E.P. Philippens
- Department of Radiation Oncology, University Medical Center, HP Q 00.3.11, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - J.J.C. Verhoeff
- Department of Radiation Oncology, University Medical Center, HP Q 00.3.11, PO Box 85500, 3508 GA Utrecht, the Netherlands
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van Grinsven EE, Nagtegaal SHJ, Verhoeff JJC, van Zandvoort MJE. The Impact of Stereotactic or Whole Brain Radiotherapy on Neurocognitive Functioning in Adult Patients with Brain Metastases: A Systematic Review and Meta-Analysis. Oncol Res Treat 2021; 44:622-636. [PMID: 34482312 DOI: 10.1159/000518848] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022]
Abstract
Background & Objectives: Radiotherapy is standard treatment for patients with brain metastases (BMs), although it may lead to radiation-induced cognitive impairment. This review explores the impact of whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) on cognition. METHODS The PRISMA guidelines were used to identify articles on PubMed and EmBase reporting on objective assessment of cognition before, and at least once after radiotherapy, in adult patients with nonresected BMs. RESULTS Of the 867 records screened, twenty articles (14 unique studies) were included. WBRT lead to decline in cognitive performance, which stabilized or returned to baseline in patients with survival of at least 9-15 months. For SRS, a decline in cognitive performance was sometimes observed shortly after treatment, but the majority of patients returned to or remained at baseline until a year after treatment. CONCLUSIONS These findings suggest that after WBRT, patients can experience deterioration over a longer period of time. The cognitive side effects of SRS are transient. Therefore, this review advices to choose SRS as this will result in lowest risks for cognitive adverse side effects, irrespective of predicted survival. In an already cognitively vulnerable patient population with limited survival, this information can be used in communicating risks and aid in making educated decisions.
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Affiliation(s)
- Eva Elisabeth van Grinsven
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Steven H J Nagtegaal
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology & Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.,Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Connor M, Kim MM, Cao Y, Hattangadi-Gluth J. Precision Radiotherapy for Gliomas: Implementing Novel Imaging Biomarkers to Improve Outcomes With Patient-Specific Therapy. Cancer J 2021; 27:353-363. [PMID: 34570449 PMCID: PMC8480523 DOI: 10.1097/ppo.0000000000000546] [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] [Indexed: 11/27/2022]
Abstract
ABSTRACT Gliomas are the most common primary brain cancer, yet are extraordinarily challenging to treat because they can be aggressive and infiltrative, locally recurrent, and resistant to standard treatments. Furthermore, the treatments themselves, including radiation therapy, can affect patients' neurocognitive function and quality of life. Noninvasive imaging is the standard of care for primary brain tumors, including diagnosis, treatment planning, and monitoring for treatment response. This article explores the ways in which advanced imaging has and will continue to transform radiation treatment for patients with gliomas, with a focus on cognitive preservation and novel biomarkers, as well as precision radiotherapy and treatment adaptation. Advances in novel imaging techniques continue to push the field forward, to more precisely guided treatment planning, radiation dose escalation, measurement of therapeutic response, and understanding of radiation-associated injury.
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Affiliation(s)
- Michael Connor
- From the Department of Radiation Medicine and Applied Sciences, UC San Diego, Moores Cancer Center, La Jolla, CA
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Jona Hattangadi-Gluth
- From the Department of Radiation Medicine and Applied Sciences, UC San Diego, Moores Cancer Center, La Jolla, CA
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Voshart DC, Wiedemann J, van Luijk P, Barazzuol L. Regional Responses in Radiation-Induced Normal Tissue Damage. Cancers (Basel) 2021; 13:cancers13030367. [PMID: 33498403 PMCID: PMC7864176 DOI: 10.3390/cancers13030367] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Normal tissue side effects remain a major concern in radiotherapy. The improved precision of radiation dose delivery of recent technological developments in radiotherapy has the potential to reduce the radiation dose to organ regions that contribute the most to the development of side effects. This review discusses the contribution of regional variation in radiation responses in several organs. In the brain, various regions were found to contribute to radiation-induced neurocognitive dysfunction. In the parotid gland, the region containing the major ducts was found to be critical in hyposalivation. The heart and lung were each found to exhibit regional responses while also mutually affecting each other's response to radiation. Sub-structures critical for the development of side effects were identified in the pancreas and bladder. The presence of these regional responses is based on a non-uniform distribution of target cells or sub-structures critical for organ function. These characteristics are common to most organs in the body and we therefore hypothesize that regional responses in radiation-induced normal tissue damage may be a shared occurrence. Further investigations will offer new opportunities to reduce normal tissue side effects of radiotherapy using modern and high-precision technologies.
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Affiliation(s)
- Daniëlle C. Voshart
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Julia Wiedemann
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
| | - Lara Barazzuol
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
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Carr CM, Benson JC, DeLone DR, Diehn FE, Kim DK, Merrell KW, Nagelschneider AA, Madhavan AA, Johnson DR. Intracranial long-term complications of radiation therapy: an image-based review. Neuroradiology 2021; 63:471-482. [PMID: 33392738 DOI: 10.1007/s00234-020-02621-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Radiation therapy is commonly utilized in the majority of solid cancers and many hematologic malignancies and other disorders. While it has an undeniably major role in improving cancer survival, radiation therapy has long been recognized to have various negative effects, ranging from mild to severe. In this manuscript, we review several intracranial manifestations of therapeutic radiation, with particular attention to those that may be encountered by radiologists. METHODS We conducted an extensive literature review of known complications of intracranial radiation therapy. Based on this review, we selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications, focusing only on patients who had a history of intracranial radiation therapy. We then selected cases that best exemplified expected imaging findings in these entities. RESULTS Based on our initial literature search and imaging database review, we selected cases of radiation-induced meningioma, radiation-induced glioma, cavernous malformation, enlarging perivascular spaces, leukoencephalopathy, stroke-like migraine after radiation therapy, Moyamoya syndrome, radiation necrosis, radiation-induced labyrinthitis, optic neuropathy, and retinopathy. Although retinopathy is not typically apparent on imaging, it has been included given its clinical overlap with optic neuropathy. CONCLUSIONS We describe the clinical and imaging features of selected sequelae of intracranial radiation therapy, with a focus on those most relevant to practicing radiologists. Knowledge of these complications and their imaging findings is important, because radiologists play a key role in early detection of these entities.
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Affiliation(s)
- Carrie M Carr
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R DeLone
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Alex A Nagelschneider
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ajay A Madhavan
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Khan RB, Bano M, Wang F, Haitao P, Christensen A, Smith J, Simmons A, Sadighi Z. Height, weight, and cardiovascular effects of stimulants on children with brain tumors. Pediatr Blood Cancer 2021; 68:e28740. [PMID: 33049111 PMCID: PMC7872133 DOI: 10.1002/pbc.28740] [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: 04/17/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Children with brain tumors may develop inattention, slow processing, and hypersomnia. Stimulant medications improve these problems, but their effect on growth, heart rate, and blood pressure (BP) are inadequately explored. PROCEDURE We retrospectively studied children with brain tumors treated at our institution that had data available for 1 year pre and 2 years on stimulant treatment. Tumor location, gender, radiation treatment (RT), age at RT, drug type, and hormone therapy were variables of interest. RESULTS We identified 65 children (35 males) that fulfilled eligibility criteria. Focal RT was utilized in 58; 11 additionally had whole brain RT; and seven received no RT. Thirty were treated for hypersomnia and inattention, eight for hypersomnia alone, and rest for inattention. Modafinil was the first drug in 18 (27.7%), and methylphenidate in the others. Forty-seven (72.3%), 45 (69.2%), and 49 (75.4%) were on thyroxine, cortisone, and growth hormones, respectively. There was no difference in pre- and post-stimulant body mass index (BMI), heart rate, and BP. There was also no difference between modafinil and methylphenidate groups. Rate of height acquisition slowed on stimulants (P = .0096). Thyroxine treatment correlated with increase in BMI after stimulants (P = .04). Younger age (P = .0003) and higher prestimulant BMI (P = .0063) correlated with increased heart rate on stimulants, while higher age at RT (P =.016) correlated with elevated systolic BP on stimulants. No associations were found with height acquisition and diastolic BP. CONCLUSION Stimulants are well tolerated by children with brain tumors that are appropriately managed for endocrine deficiencies, but may reduce the trajectory of height attainment.
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Affiliation(s)
- Raja B. Khan
- Division of Neurology, St. Children’s Research Hospital, Memphis, TN, USA
| | - Maha Bano
- Department of Pediatrics, University of Tennessee, Memphis, TN, USA
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Pan Haitao
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Anthony Christensen
- Pharmaceutical Services, St. Jude Children’s research Hospital, Memphis, TN, USA
| | - Jessica Smith
- Division of Neurology, St. Children’s Research Hospital, Memphis, TN, USA
| | - Andrea Simmons
- Division of Neurology, St. Children’s Research Hospital, Memphis, TN, USA
| | - Zsila Sadighi
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Dose-dependent volume loss in subcortical deep grey matter structures after cranial radiotherapy. Clin Transl Radiat Oncol 2020; 26:35-41. [PMID: 33294645 PMCID: PMC7691672 DOI: 10.1016/j.ctro.2020.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Subcortical grey matter is susceptible to dose-dependent volume loss after RT. Hippocampal age increases 1 year after radiotherapy, by a median of 11 years. We may need to reconsider current sparing strategies in RT for brain tumours. Future studies should examine the impact of deep GM volume loss on cognition.
Background and purpose The relation between radiotherapy (RT) dose to the brain and morphological changes in healthy tissue has seen recent increased interest. There already is evidence for changes in the cerebral cortex and white matter, as well as selected subcortical grey matter (GM) structures. We studied this relation in all deep GM structures, to help understand the aetiology of post-RT neurocognitive symptoms. Materials and methods We selected 31 patients treated with RT for grade II-IV glioma. Pre-RT and 1 year post-RT 3D T1-weighted MRIs were automatically segmented, and the changes in volume of the following structures were assessed: amygdala, nucleus accumbens, caudate nucleus, hippocampus, globus pallidus, putamen, and thalamus. The volumetric changes were related to the mean RT dose received by each structure. Hippocampal volumes were entered into a population-based nomogram to estimate hippocampal age. Results A significant relation between RT dose and volume loss was seen in all examined structures, except the caudate nucleus. The volume loss rates ranged from 0.16 to 1.37%/Gy, corresponding to 4.9–41.2% per 30 Gy. Hippocampal age, as derived from the nomogram, was seen to increase by a median of 11 years. Conclusion Almost all subcortical GM structures are susceptible to radiation-induced volume loss, with higher volume loss being observed with increasing dose. Volume loss of these structures is associated with neurological deterioration, including cognitive decline, in neurodegenerative diseases. To support a causal relationship between radiation-induced deep GM loss and neurocognitive functioning in glioma patients, future studies are needed that directly correlate volumetrics to clinical outcomes.
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Key Words
- Amygdala
- Brain neoplasms
- CAT12, computational anatomy toolbox 12
- CT, computed tomography
- Caudate nucleus
- FWER, family-wise error rate
- GM, grey matter
- Globus pallidus
- Gray matter
- Hippocampus
- MRI, magnetic resonance imaging
- Nucleus accumbens
- PALM, permutation analysis of linear models
- PTV, planning target volume
- Putamen
- RT, radiotherapy
- Radiotherapy
- SPM, statistical parametric mapping
- TFE, turbo fast echo
- Thalamus
- WBRT, whole-brain radiotherapy
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