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Marino N, Bedeschi M, Vaccari ME, Cambiaghi M, Tesei A. Glitches in the brain: the dangerous relationship between radiotherapy and brain fog. Front Cell Neurosci 2024; 18:1328361. [PMID: 38515789 PMCID: PMC10956129 DOI: 10.3389/fncel.2024.1328361] [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: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Up to approximately 70% of cancer survivors report persistent deficits in memory, attention, speed of information processing, multi-tasking, and mental health functioning, a series of symptoms known as "brain fog." The severity and duration of such effects can vary depending on age, cancer type, and treatment regimens. In particular, every year, hundreds of thousands of patients worldwide undergo radiotherapy (RT) for primary brain tumors and brain metastases originating from extracranial tumors. Besides its potential benefits in the control of tumor progression, recent studies indicate that RT reprograms the brain tumor microenvironment inducing increased activation of microglia and astrocytes and a consequent general condition of neuroinflammation that in case it becomes chronic could lead to a cognitive decline. Furthermore, radiation can induce endothelium reticulum (ER) stress directly or indirectly by generating reactive oxygen species (ROS) activating compensatory survival signaling pathways in the RT-surviving fraction of healthy neuronal and glial cells. In particular, the anomalous accumulation of misfolding proteins in neuronal cells exposed to radiation as a consequence of excessive activation of unfolded protein response (UPR) could pave the way to neurodegenerative disorders. Moreover, exposure of cells to ionizing radiation was also shown to affect the normal proteasome activity, slowing the degradation rate of misfolded proteins, and further exacerbating ER-stress conditions. This compromises several neuronal functions, with neuronal accumulation of ubiquitinated proteins with a consequent switch from proteasome to immunoproteasome that increases neuroinflammation, a crucial risk factor for neurodegeneration. The etiology of brain fog remains elusive and can arise not only during treatment but can also persist for an extended period after the end of RT. In this review, we will focus on the molecular pathways triggered by radiation therapy affecting cognitive functions and potentially at the origin of so-called "brain fog" symptomatology, with the aim to define novel therapeutic strategies to preserve healthy brain tissue from cognitive decline.
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Affiliation(s)
- Noemi Marino
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Martina Bedeschi
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Melania Elettra Vaccari
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Marco Cambiaghi
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Tesei
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
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Alattar AA, Dhawan S, Bartek J, Carroll K, Ma J, Sanghvi P, Chen CC. Increased risk for ex-vacuo ventriculomegaly with leukoencephalopathy (EVL) in whole brain radiation therapy and repeat radiosurgery treated brain metastasis patients. J Clin Neurosci 2023; 115:95-100. [PMID: 37541084 DOI: 10.1016/j.jocn.2023.07.005] [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: 01/15/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Cerebral atrophy with leukoencephalopathy is a known morbidity after whole brain radiation therapy (WBRT), resulting in ex-vacuo ventriculomegaly with leukoencephalopathy (EVL). Here we studied the correlation between WBRT, stereotactic radiosurgery (SRS), and risk for EVL in brain metastases patients. METHODS In a retrospective study, we identified 195 patients (with 1,018 BM) who underwent SRS for BM (2007-2017) and had > 3 months of MRI follow-up. All patients who underwent ventriculoperitoneal shunting were excluded. Cerebral atrophy was measured by ex-vacuo-ventriculomegaly, defined based on Evans' criteria. Demographic and clinical variables were analyzed using logistic regression models. RESULTS Ex-vacuo ventriculomegaly was observed on pre-radiosurgery imaging in 29.7% (58/195) of the study cohort. On multivariate analysis, older age was the only variable associated with pre-radiosurgery ventriculomegaly. Of the 137 patients with normal ventricular size before radiosurgery, 27 (19.7 %) developed ex-vacuo ventriculomegaly and leukoencephalopathy (EVL) post-SRS. In univariate analysis, previous whole brain radiation therapy was the main factor associated with increased risk for developing EVL (OR = 5.08, p < 0.001). In bivariate models that included prior receipt of WBRT, both the number of SRS treatments (OR = 1.499, p = 0.025) and WBRT (OR = 11.321, p = 0.003 were independently associated with increased EVL risk. CONCLUSIONS While repeat radiosurgery contributes to the risk of EVL in BM patients, this risk is ∼20-fold lower than that associated with WBRT.
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Affiliation(s)
- Ali A Alattar
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Kate Carroll
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
| | - Jun Ma
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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3
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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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4
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Stereotactic radiosurgery in brain metastasis: treatment outcomes and patterns of failure. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396922000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction:
Stereotactic radiosurgery (SRS) has become a preferred treatment in the initial management of brain metastases (BM). This study reported treatment outcomes and identified the patient, tumour, and treatment-related factors that predict failure, survival, and brain necrosis (BN).
Methods:
We retrospectively reviewed the electronic medical records of all BM patients treated with SRS. Patient, tumour characteristics and treatment details data were collected. All recurrences and BN were defined in the neurooncological tumour board.
Results:
From December 2016 to April 2020, 148 patients were analysed. The median follow-up was 14·8 months (range 6–51). At the time of analyses, 72·3% of the patients were alive. Presence of initial neurological deficit (HR; 2·71 (1·07–6·9); p = 0·036) and prior RT (HR; 2·55 (1·28–5·09); p = 0·008) is associated with worse overall survival. The local recurrence rate was 11·5 %. The distant brain metastasis rate was 53·4 %. Leptomeningeal metastasis was seen in 11 patients (7·4%). Symptomatic BN was seen in 19 patients (12·8 %). Bigger lesions (13 versus 23 mm diameter; p = 0·034) and cavity radiosurgery are associated with more BN (63·2 % versus 36·8%; p: 0·004).
Conclusions:
Distant BM is the leading cause of CNS recurrences and, salvage SRS is possible. Due to the increasing risk of developing BN routine metastasectomy should be made with caution.
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Du L, Zhu G, Xu Y, Han B, Wang Y, Zhu M, Meng Y, Chen H, Yu Z. Integrated radiochemotherapy study of ZIF-8 coated with osteosarcoma-platelet hybrid membranes for the delivery of Dbait and Adriamycin. Front Bioeng Biotechnol 2023; 11:1147064. [PMID: 36873373 PMCID: PMC9981937 DOI: 10.3389/fbioe.2023.1147064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction: The toxic side effects of systemic high-dose chemotherapy and poor sensitivity to radiotherapy hinder the survival rate of patients with osteosarcoma (OS). Nanotechnology offers new solutions for OS treatment; however, conventional nanocarriers suffer from inadequate targeting of tumors and short in vivo circulation time. Methods: Here, we designed a novel drug delivery system, [Dbait-ADM@ZIF-8]OPM, which uses OS-platelet hybrid membranes to encapsulate nanocarriers, to enhance the targeting and circulation time of nanocarriers, thereby enabling high enrichment of the nanocarriers in OS sites. Results: In the tumor microenvironment, the pH-sensitive nanocarrier, which is the metal-organic framework ZIF-8, dissociates to release radiosensitizer Dbait and the classical chemotherapeutic agent Adriamycin for the integrated treatment of OS via radiotherapy and chemotherapy. Benefiting from the excellent targeting ability of the hybrid membrane and the outstanding drug loading capacity of the nanocarrier, [Dbait-ADM@ZIF-8]OPM showed potent anti-tumor effects in tumor-bearing mice with almost no significant biotoxicity. Conclusion: Overall, this project is a successful exploration of the combination of radiotherapy and chemotherapy of OS treatment. Our findings solve the problems of the insensitivity of OS to radiotherapy and the toxic side effects of chemotherapy. Furthermore, this study is an expansion of the research of OS nanocarriers and provides new potential treatments for OS.
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Affiliation(s)
- Longhai Du
- Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Guanghao Zhu
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yanlong Xu
- Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Binxu Han
- Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yu Wang
- Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Minhui Zhu
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yingdi Meng
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Huaiwen Chen
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zuochong Yu
- Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, China
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6
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Liu CW, Yang HC, Chiang CL, Shen CI, Wu HM, Luo YH, Hu YS, Lin CJ, Chung WY, Shiau CY, Guo WY, Pan DHC, Lee CC. Leukoencephalopathy in patients with brain metastases who received radiosurgery with or without whole brain radiotherapy. J Neurooncol 2023; 161:85-95. [PMID: 36544061 DOI: 10.1007/s11060-022-04210-5] [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: 08/21/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whole brain radiation therapy (WBRT) for brain metastases (BMs) is a common cause of radiation-induced leukoencephalopathy; however the safety of alternative stereotactic radiosurgery (SRS) remains unclear. This study examined the incidence of leukoencephalopathy in patients treated with SRS alone versus WBRT plus SRS for BMs with a focus on the relationship between prognostic factors and leukoencephalopathy. METHODS Analysis was performed between 2002 and 2021. The total enrollment was 993 patients with the distribution: WBRT plus SRS (n = 291) and SRS only (n = 702). Leukoencephalopathy was graded from 0 to 3 for changes in white matter indicated by the MRI after WBRT or SRS. Patient characteristics and SRS dosimetric parameters were reviewed to identify factors that contributed to the incidence of leukoencephalopathy or overall survival. RESULTS The incidence of leukoencephalopathy was consistently higher in WBRT plus SRS group than in SRS alone group (p < 0.001). Leukoencephalopathy was also associated with a larger total tumor volume (≧28cm3; p = 0.028) and age (> 77 years; p = 0.025). Nonetheless, the SRS integral dose to skull in the subgroup of WBRT plus SRS treatment was not demonstrated significance in development of leukoencephalopathy (p = 0.986 for integral dose 1-2 J, p = 0.776 for integral dose > 2 J). CONCLUSIONS This study revealed that SRS is safe for oligo-BMs in terms of leukoencephalopathy development. Patient age and total tumor volume were identified as important factors in assessing the development of leukoencephalopathy. The additional of SRS (even at an integral dose > 2 J) did not increase the incidence of leukoencephalopathy.
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Affiliation(s)
- Chan-Wei Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Lu Chiang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-I Shen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Hung Luo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yong-Sin Hu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Ying Shiau
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 17F, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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7
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Karz A, Dimitrova M, Kleffman K, Alvarez-Breckenridge C, Atkins MB, Boire A, Bosenberg M, Brastianos P, Cahill DP, Chen Q, Ferguson S, Forsyth P, Glitza Oliva IC, Goldberg SB, Holmen SL, Knisely JPS, Merlino G, Nguyen DX, Pacold ME, Perez-Guijarro E, Smalley KSM, Tawbi HA, Wen PY, Davies MA, Kluger HM, Mehnert JM, Hernando E. Melanoma central nervous system metastases: An update to approaches, challenges, and opportunities. Pigment Cell Melanoma Res 2022; 35:554-572. [PMID: 35912544 PMCID: PMC10171356 DOI: 10.1111/pcmr.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 01/27/2023]
Abstract
Brain metastases are the most common brain malignancy. This review discusses the studies presented at the third annual meeting of the Melanoma Research Foundation in the context of other recent reports on the biology and treatment of melanoma brain metastases (MBM). Although symptomatic MBM patients were historically excluded from immunotherapy trials, efforts from clinicians and patient advocates have resulted in more inclusive and even dedicated clinical trials for MBM patients. The results of checkpoint inhibitor trials were discussed in conversation with current standards of care for MBM patients, including steroids, radiotherapy, and targeted therapy. Advances in the basic scientific understanding of MBM, including the role of astrocytes and metabolic adaptations to the brain microenvironment, are exposing new vulnerabilities which could be exploited for therapeutic purposes. Technical advances including single-cell omics and multiplex imaging are expanding our understanding of the MBM ecosystem and its response to therapy. This unprecedented level of spatial and temporal resolution is expected to dramatically advance the field in the coming years and render novel treatment approaches that might improve MBM patient outcomes.
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Affiliation(s)
- Alcida Karz
- Department of Pathology, NYU Grossman School of Medicine, New York, USA.,Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, NYU Langone Health, New York, USA
| | - Maya Dimitrova
- Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, NYU Langone Health, New York, USA.,Department of Medicine, NYU Grossman School of Medicine, New York, USA
| | - Kevin Kleffman
- Department of Pathology, NYU Grossman School of Medicine, New York, USA.,Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, NYU Langone Health, New York, USA
| | | | - Michael B Atkins
- Georgetown-Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Adrienne Boire
- Human Oncology and Pathogenesis Program, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Marcus Bosenberg
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research NCI, NIH, USA
| | - Priscilla Brastianos
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Qing Chen
- Immunology, Microenvironment and Metastasis Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Sherise Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Forsyth
- Department of Neuro-Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah B Goldberg
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Sheri L Holmen
- Huntsman Cancer Institute and Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Jonathan P S Knisely
- Meyer Cancer Center and Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Glenn Merlino
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research NCI, NIH, USA
| | - Don X Nguyen
- Department of Pathology, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael E Pacold
- Department of Radiation Oncology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Eva Perez-Guijarro
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research NCI, NIH, USA
| | - Keiran S M Smalley
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, United States, Boston, Massachusetts, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harriet M Kluger
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Janice M Mehnert
- Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, NYU Langone Health, New York, USA.,Department of Medicine, NYU Grossman School of Medicine, New York, USA
| | - Eva Hernando
- Department of Pathology, NYU Grossman School of Medicine, New York, USA.,Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, NYU Langone Health, New York, USA
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8
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Tohidinezhad F, Di Perri D, Zegers CML, Dijkstra J, Anten M, Dekker A, Van Elmpt W, Eekers DBP, Traverso A. Prediction Models for Radiation-Induced Neurocognitive Decline in Adult Patients With Primary or Secondary Brain Tumors: A Systematic Review. Front Psychol 2022; 13:853472. [PMID: 35432113 PMCID: PMC9009149 DOI: 10.3389/fpsyg.2022.853472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose Although an increasing body of literature suggests a relationship between brain irradiation and deterioration of neurocognitive function, it remains as the standard therapeutic and prophylactic modality in patients with brain tumors. This review was aimed to abstract and evaluate the prediction models for radiation-induced neurocognitive decline in patients with primary or secondary brain tumors. Methods MEDLINE was searched on October 31, 2021 for publications containing relevant truncation and MeSH terms related to “radiotherapy,” “brain,” “prediction model,” and “neurocognitive impairments.” Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool. Results Of 3,580 studies reviewed, 23 prediction models were identified. Age, tumor location, education level, baseline neurocognitive score, and radiation dose to the hippocampus were the most common predictors in the models. The Hopkins verbal learning (n = 7) and the trail making tests (n = 4) were the most frequent outcome assessment tools. All studies used regression (n = 14 linear, n = 8 logistic, and n = 4 Cox) as machine learning method. All models were judged to have a high risk of bias mainly due to issues in the analysis. Conclusion Existing models have limited quality and are at high risk of bias. Following recommendations are outlined in this review to improve future models: developing cognitive assessment instruments taking into account the peculiar traits of the different brain tumors and radiation modalities; adherence to model development and validation guidelines; careful choice of candidate predictors according to the literature and domain expert consensus; and considering radiation dose to brain substructures as they can provide important information on specific neurocognitive impairments.
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Affiliation(s)
- Fariba Tohidinezhad
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Dario Di Perri
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Catharina M L Zegers
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Jeanette Dijkstra
- Department of Medical Psychology, School for Mental Health and Neurosciences (MHeNS), Maastricht University Medical Center, Maastricht, Netherlands
| | - Monique Anten
- Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Wouter Van Elmpt
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
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9
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Országhová Z, Mego M, Chovanec M. Long-Term Cognitive Dysfunction in Cancer Survivors. Front Mol Biosci 2022; 8:770413. [PMID: 34970595 PMCID: PMC8713760 DOI: 10.3389/fmolb.2021.770413] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer-related cognitive impairment (CRCI) is a frequent side effect experienced by an increasing number of cancer survivors with a significant impact on their quality of life. Different definitions and means of evaluation have been used in available literature; hence the exact incidence of CRCI remains unknown. CRCI can be described as cognitive symptoms reported by cancer patients in self-reported questionnaires or as cognitive changes evaluated by formal neuropsychological tests. Nevertheless, association between cognitive symptoms and objectively assessed cognitive changes is relatively weak or absent. Studies have focused especially on breast cancer patients, but CRCI has been reported in multiple types of cancer, including colorectal, lung, ovarian, prostate, testicular cancer and hematological malignancies. While CRCI has been associated with various treatment modalities, including radiotherapy, chemotherapy, hormone therapy and novel systemic therapies, it has been also detected prior to cancer treatment. Therefore, the effects of cancer itself with or without the psychological distress may be involved in the pathogenesis of CRCI as a result of altered coping mechanisms after cancer diagnosis. The development of CRCI is probably multifactorial and the exact mechanisms are currently not completely understood. Possible risk factors include administered treatment, genetic predisposition, age and psychological factors such as anxiety, depression or fatigue. Multiple mechanisms are suggested to be responsible for CRCI, including direct neurotoxic injury of systemic treatment and radiation while other indirect contributing mechanisms are hypothesized. Chronic neuroinflammation mediated by active innate immune system, DNA-damage or endothelial dysfunction is hypothesized to be a central mechanism of CRCI pathogenesis. There is increasing evidence of potential plasma (e.g., damage associated molecular patterns, inflammatory components, circulating microRNAs, exosomes, short-chain fatty acids, and others), cerebrospinal fluid and radiological biomarkers of cognitive dysfunction in cancer patients. Discovery of biomarkers of cognitive impairment is crucial for early identification of cancer patients at increased risk for the development of CRCI or development of treatment strategies to lower the burden of CRCI on long-term quality of life. This review summarizes current literature on CRCI with a focus on long-term effects of different cancer treatments, possible risk factors, mechanisms and promising biomarkers.
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Affiliation(s)
- Zuzana Országhová
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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10
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Kocher M, Jockwitz C, Lerche C, Sabel M, Lohmann P, Stoffels G, Filss C, Mottaghy FM, Ruge MI, Fink GR, Shah NJ, Galldiks N, Caspers S, Langen KJ. Case Report: Disruption of Resting-State Networks and Cognitive Deficits After Whole Brain Irradiation for Singular Brain Metastasis. Front Neurosci 2021; 15:738708. [PMID: 34776847 PMCID: PMC8578854 DOI: 10.3389/fnins.2021.738708] [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: 07/09/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Long-term survivors of whole brain radiation (WBRT) are at significant risk for developing cognitive deficits, but knowledge about the underlying pathophysiological mechanisms is limited. Therefore, we here report a rare case with a singular brain metastasis treated by resection and WBRT that survived for more than 10 years where we investigated the integrity of brain networks using resting-state functional MRI. Methods: A female patient with a left frontal non-small cell lung cancer (NSCLC) brain metastasis had resection and postoperative WBRT (30.0 in 3.0 Gy fractions) and stayed free from brain metastasis recurrence for a follow-up period of 11 years. Structural magnetic resonance imaging (MRI) and amino acid [O-(2-[18F]fluoroethyl)-L-tyrosine] positron emission tomography (FET PET) were repeatedly acquired. At the last follow up, neurocognitive functions and resting-state functional connectivity (RSFC) using resting-state fMRI were assessed. Within-network and inter-network connectivity of seven resting-state networks were computed from a connectivity matrix. All measures were compared to a matched group of 10 female healthy subjects. Results: At the 11-year follow-up, T2/FLAIR MR images of the patient showed extended regions of hyper-intensities covering mainly the white mater of the bilateral dorsal frontal and parietal lobes while sparing most of the temporal lobes. Compared to the healthy subjects, the patient performed significantly worse in all cognitive domains that included executive functions, attention and processing speed, while verbal working memory, verbal episodic memory, and visual working memory were left mostly unaffected. The connectivity matrix showed a heavily disturbed pattern with a widely distributed, scattered loss of RSFC. The within-network RSFC revealed a significant loss of connectivity within all seven networks where the dorsal attention and fronto-parietal control networks were affected most severely. The inter-network RSFC was significantly reduced for the visual, somato-motor, and dorsal and ventral attention networks. Conclusion: As demonstrated here in a patient with a metastatic NSCLC and long-term survival, WBRT may lead to extended white matter damage and cause severe disruption of the RSFC in multiple resting state networks. In consequence, executive functioning which is assumed to depend on the interaction of several networks may be severely impaired following WBRT apart from the well-recognized deficits in memory function.
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Affiliation(s)
- Martin Kocher
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany
| | - Christiane Jockwitz
- Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, Juelich, Germany.,Institute for Anatomy I, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Christoph Lerche
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
| | - Michael Sabel
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany.,Department of Neurosurgery, Medical Faculty, Center of Neuro-Oncology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
| | - Christian Filss
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Felix M Mottaghy
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Maximilian I Ruge
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany
| | - Gereon R Fink
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany.,Department of Neurology, University Hospital Aachen, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University, Aachen, Germany.,Juelich-Aachen Research Alliance-Section JARA-Brain, Juelich, Germany
| | - Norbert Galldiks
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Center Juelich, Juelich, Germany.,Institute for Anatomy I, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne and Duesseldorf, Cologne, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University, Aachen, Germany.,Juelich-Aachen Research Alliance-Section JARA-Brain, Juelich, Germany
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11
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Milano MT, Chiang VLS, Soltys SG, Wang TJC, Lo SS, Brackett A, Nagpal S, Chao S, Garg AK, Jabbari S, Halasz LM, Gephart MH, Knisely JPS, Sahgal A, Chang EL. Executive summary from American Radium Society's appropriate use criteria on neurocognition after stereotactic radiosurgery for multiple brain metastases. Neuro Oncol 2021; 22:1728-1741. [PMID: 32780818 DOI: 10.1093/neuonc/noaa192] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The American Radium Society (ARS) Appropriate Use Criteria brain malignancies panel systematically reviewed (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses]) published literature on neurocognitive outcomes after stereotactic radiosurgery (SRS) for patients with multiple brain metastases (BM) to generate consensus guidelines. METHODS The panel developed 4 key questions (KQs) to guide systematic review. From 11 614 original articles, 12 were selected. The panel developed model cases addressing KQs and potentially controversial scenarios not addressed in the systematic review (which might inform future ARS projects). Based upon quality of evidence, the panel confidentially voted on treatment options using a 9-point scale of appropriateness. RESULTS The panel agreed that SRS alone is usually appropriate for those with good performance status and 2-10 asymptomatic BM, and usually not appropriate for >20 BM. For 11-15 and 16-20 BM there was (between 2 case variants) agreement that SRS alone may be appropriate or disagreement on the appropriateness of SRS alone. There was no scenario (among 6 case variants) in which conventional whole-brain radiotherapy (WBRT) was considered usually appropriate by most panelists. There were several areas of disagreement, including: hippocampal sparing WBRT for 2-4 asymptomatic BM; WBRT for resected BM amenable to SRS; fractionated versus single-fraction SRS for resected BM, larger targets, and/or brainstem metastases; optimal treatment (WBRT, hippocampal sparing WBRT, SRS alone to all or select lesions) for patients with progressive extracranial disease, poor performance status, and no systemic options. CONCLUSIONS For patients with 2-10 BM, SRS alone is an appropriate treatment option for well-selected patients with good performance status. Future study is needed for those scenarios in which there was disagreement among panelists.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY
| | - Veronica L S Chiang
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, CT
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CT
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Alexandria Brackett
- Cushing/Whitney Medical Library, Yale School of Medicine, Yale University, New Haven, CT
| | - Seema Nagpal
- Department of Neurology, Stanford University School of Medicine, Stanford, CT
| | - Samuel Chao
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Amit K Garg
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Albuquerque, NM
| | - Siavash Jabbari
- Laurel Amtower Cancer Institute and Neuro-oncology Center, Sharp Healthcare, San Diego, CA
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | | | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, Cornell University, New York, NY
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, CA
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12
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Velten C, Kabarriti R, Garg M, Tomé WA. Single isocenter treatment planning techniques for stereotactic radiosurgery of multiple cranial metastases. Phys Imaging Radiat Oncol 2021; 17:47-52. [PMID: 33898778 PMCID: PMC8058031 DOI: 10.1016/j.phro.2021.01.002] [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: 07/13/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/05/2022] Open
Abstract
DCA in most cases is superior to VMAT for multi metastases single isocenter SRS. Normal brain V12Gy was significantly reduced with DCA, predicting for lower S-NEC. Maximum doses to critical organs-at-risk were significantly lower with DCA. Conformity was comparable between VMAT and DCA.
Background and purpose Whole brain radiation therapy use has decreased in favor of stereotactic radiosurgery (SRS) for the treatment of multiple brain metastases due to reduced neurotoxicity. Here we compare two single isocenter radiosurgery planning techniques, volumetric modulated arc therapy (VMAT) and dynamic conformal arcs (DCA) in terms of their dosimetric and delivery performance. Materials and methods Sixteen patients with 2– 18 brain metastases (total 103; median 4) previously treated with single fraction SRS were replanned for multiple lesion single isocenter treatments using VMAT and DCA using different treatment planning systems for each and three different plan geometries for DCA. Plans were evaluated using the Paddick conformity index, normal tissue V12Gy, the probability for symptomatic brain necrosis (S-NEC), maximum organ-at-risk (OAR) point doses, and total number of monitor units (MU). Results Conformity was not significantly different between VMAT and DCA plans. VMAT plans showed a trend towards higher MU with a median difference between 18% and 24% (p ≤ 0.09). Median V12Gy differences were 7.0 cm3–8.6 cm3 favoring DCA plans (p < 0.01). VMAT plans had median excess absolute and relative S-NEC risks compared to DCA plans of 8%–10% and 25%–31%, respectively (p < 0.01). Moreover for VMAT compared to DCA, maximum OAR doses were significantly higher for the brainstem (1.9 Gy; p < 0.01), chiasm (0.5 Gy; p ≤ 0.02), and optic nerves (0.5 Gy; p ≤ 0.04). Conclusions In most cases DCA plans were found to be dosimetrically superior to VMAT plans with reduced V12Gy and associated risk for S-NEC. Maximum doses to important OARs showed significant improvement, increasing the ability for subsequent salvage treatments involving radiation.
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Affiliation(s)
- Christian Velten
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA.,Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA.,Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA.,Albert Einstein College of Medicine, Bronx, NY 10461, USA
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13
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Kraft J, Mayinger M, Willmann J, Brown M, Tanadini-Lang S, Wilke L, Guckenberger M, Andratschke N. Management of multiple brain metastases: a patterns of care survey within the German Society for Radiation Oncology. J Neurooncol 2021; 152:395-404. [PMID: 33620657 PMCID: PMC7997832 DOI: 10.1007/s11060-021-03714-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The treatment of brain metastases (BM) has changed considerably in recent years and in particular, the management of multiple BM is currently undergoing a paradigm shift and treatment may differ from current guidelines. This survey was designed to analyze the patterns of care in the management of multiple BM. METHODS An online survey consisting of 36 questions was distributed to the members of the German Society for Radiation Oncology (DEGRO). RESULTS In total, 193 physicians out of 111 institutions within the German Society for Radiation oncology responded to the survey. Prognostic scores for decision making were not used regularly. Whole brain radiotherapy approaches (WBRT) are the preferred treatment option for patients with multiple BM, although stereotactic radiotherapy treatments are chosen by one third depending on prognostic scores and overall number of BM. Routine hippocampal avoidance (HA) in WBRT is only used by a minority. In multiple BM of driver-mutated non-small cell lung cancer origin up to 30% favor sole TKI therapy as upfront treatment and would defer upfront radiotherapy. CONCLUSION In multiple BM WBRT without hippocampal avoidance is still the preferred treatment modality of choice regardless of GPA and mutational status, while SRT is only used in patients with good prognosis. Evidence for both, SRS and hippocampal avoidance radiotherapy, is growing albeit the debate over the appropriate treatment in multiple BM is yet not fully clarified. Further prospective assessment of BM management-ideally as randomized trials-is required to align evolving concepts with the proper evidence and to update current guidelines.
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Affiliation(s)
- Johannes Kraft
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland.
| | - Michael Mayinger
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | - Jonas Willmann
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | - Michelle Brown
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | | | - Lotte Wilke
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
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14
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MRI-based brain structural changes following radiotherapy of Nasopharyngeal Carcinoma: A systematic review. Cancer Radiother 2021; 25:62-71. [PMID: 33414057 DOI: 10.1016/j.canrad.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) radiotherapy (RT) irradiates parts of the brain which may cause cerebral tissue changes. This study aimed to systematically review the brain microstructure changes using MRI-based measures, diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI) and voxel-based morphometry (VBM) and the impact of dose and latency following RT. METHODS PubMed and Scopus databases were searched based on PRISMA guideline to determine studies focusing on changes following NPC RT. RESULTS Eleven studies fulfilled the inclusion criteria. Microstructural changes occur most consistently in the temporal region. The changes were correlated with latency in seven studies; fractional anisotropy (FA) and gray matter (GM) volume remained low even after a longer period following RT and areas beyond irradiation site with reduced FA and GM measures. For dosage, only one study showed correlation, thus requiring further investigations. CONCLUSION DTI, DKI and VBM may be used as a surveillance tool in detecting brain microstructural changes of NPC patients which correlates to latency and brain areas following RT.
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15
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Wali AR, Rennert RC, Wang SG, Chen CC. Evidence-Based Recommendations for Seizure Prophylaxis in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 128:51-55. [PMID: 34191061 DOI: 10.1007/978-3-030-69217-9_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Symptomatic epilepsy is frequently encountered in patients with brain metastases (BM), affecting up to 25% of them. However, it generally remains unknown whether the risk of seizures in such cases is affected by stereotactic radiosurgery (SRS), which involves highly conformal delivery of high-dose irradiation to the tumor with a minimal effect on adjacent brain tissue. Thus, the role of prophylactic administration of antiepileptic drugs (AED) after SRS remains controversial. A comprehensive review and analysis of the available literature reveals that according to prospective studies, the incidence of seizures after SRS for BM varies from 8% to 22%, and there is no evidence that SRS increases the incidence of symptomatic epilepsy. Therefore, routine prophylactic administration of AED prior to, during, or after SRS in the absence of a seizure history is not recommended. Nevertheless, short-course administration of an AED may be judiciously considered (on the basis of class III evidence) for selected high-risk individuals.
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Affiliation(s)
- Arvin R Wali
- Department of Neurosurgery, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Sonya G Wang
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN, USA.
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16
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Constanzo J, Midavaine É, Fouquet J, Lepage M, Descoteaux M, Kirby K, Tremblay L, Masson-Côté L, Geha S, Longpré JM, Paquette B, Sarret P. Brain irradiation leads to persistent neuroinflammation and long-term neurocognitive dysfunction in a region-specific manner. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109954. [PMID: 32360786 DOI: 10.1016/j.pnpbp.2020.109954] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 01/04/2023]
Abstract
Long-term cognitive deficits are observed after treatment of brain tumors or metastases by radiotherapy. Treatment optimization thus requires a better understanding of the effects of radiotherapy on specific brain regions, according to their sensitivity and interconnectivity. In the present study, behavioral tests supported by immunohistology and magnetic resonance imaging provided a consistent picture of the persistent neurocognitive decline and neuroinflammation after the onset of irradiation-induced necrosis in the right primary somatosensory cortex of Fischer rats. Necrosis surrounded by neovascularization was first detected 54 days after irradiation and then spread to 110 days in the primary motor cortex, primary somatosensory region, striatum and right ventricle, resulting in fiber bundle disruption and demyelination in the corpus callosum of the right hemisphere. These structural damages translated into selective behavioral changes including spatial memory loss, disinhibition of anxiety-like behaviors, hyperactivity and pain hypersensitivity, but no significant alteration in motor coordination and grip strength abilities. Concomitantly, activated microglia and reactive astrocytes, accompanied by infiltration of leukocytes (CD45+) and T-cells (CD3+) cooperated to shape the neuroinflammation response. Overall, our study suggests that the slow and gradual onset of cellular damage would allow adaptation in brain regions that are susceptible to neuronal plasticity; while other cerebral structures that do not have this capacity would be more affected. The planning of radiotherapy, adjusted to the sensitivity and adaptability of brain structures, could therefore preserve certain neurocognitive functions; while higher doses of radiation could be delivered to brain areas that can better adapt to this treatment. In addition, strategies to block early post-radiation events need to be explored to prevent the development of long-term cognitive dysfunction.
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Affiliation(s)
- Julie Constanzo
- Center for Research in Radiotherapy, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Élora Midavaine
- Department of Pharmacology-Physiology, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Jérémie Fouquet
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Martin Lepage
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Maxime Descoteaux
- Computer Science Department, Université de Sherbrooke, Sherbrooke, Québec J1K 2R1, Canada
| | - Karyn Kirby
- Department of Pharmacology-Physiology, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Luc Tremblay
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Laurence Masson-Côté
- Center for Research in Radiotherapy, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada; Service of Radiation Oncology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Sameh Geha
- Department of Pathology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Jean-Michel Longpré
- Department of Pharmacology-Physiology, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Benoit Paquette
- Center for Research in Radiotherapy, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada.
| | - Philippe Sarret
- Department of Pharmacology-Physiology, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada.
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17
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Mitchell TJ, Seitzman BA, Ballard N, Petersen SE, Shimony JS, Leuthardt EC. Human Brain Functional Network Organization Is Disrupted After Whole-Brain Radiation Therapy. Brain Connect 2020; 10:29-38. [PMID: 31964163 DOI: 10.1089/brain.2019.0713] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) plays a vital role in the treatment of brain cancers, but it frequently results in cognitive decline in the patients who receive it. Because the underlying mechanisms for this decline remain poorly understood, the brain is typically treated as a single, uniform volume when evaluating the toxic effects of RT plans. This ignorance represents a significant deficit in the field of radiation oncology, as the technology exists to manipulate dose distributions to spare regions of the brain, but there exists no body of knowledge regarding what is critical to spare. This deficit exists due to the numerous confounding factors that are frequently associated with radiotherapy, including the tumors themselves, other treatments such as surgery and chemotherapy, and dose gradients across the brain. Here, we present a case in which a 57-year-old male patient received a uniform dose of radiation across the whole brain, did not receive concurrent chemotherapy, had minimal surgical intervention and a small tumor burden, and received resting-state functional magnetic resonance imaging (fMRI) scans both before and after RT. To our knowledge, this is the first study on the effects of whole-brain radiotherapy on functional network organization, and this patient's treatment regimen represents a rare and non-replicable opportunity to isolate the effects of radiation on functional connectivity. We observed substantial changes in the subject's behavior and functional network organization over a 12-month timeframe. Interestingly, the homogenous radiation dose to the brain had a heterogeneous effect on cortical networks, and the functional networks most affected correspond with observed cognitive behavioral deficits. This novel study suggests that the cognitive decline that occurs after whole-brain radiation therapy may be network specific and related to the disruption of large-scale distributed functional systems, and it indicates that fMRI is a promising avenue of study for optimizing cognitive outcomes after RT.
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Affiliation(s)
- Timothy J Mitchell
- Department of Radiation Oncology and Washington University in St. Louis-School of Medicine, St. Louis, Missouri
| | - Benjamin A Seitzman
- Department of Neurology, Washington University in St. Louis-School of Medicine, St. Louis, Missouri
| | - Nicholas Ballard
- Department of Radiation Oncology and Washington University in St. Louis-School of Medicine, St. Louis, Missouri
| | - Steven E Petersen
- Department of Neurology, Washington University in St. Louis-School of Medicine, St. Louis, Missouri.,Mallinckrodt Institute of Radiology, Washington University in St. Louis-School of Medicine, St. Louis, Missouri.,Department of Neuroscience, Washington University in St. Louis-School of Medicine, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University in St. Louis-School of Engineering and Applied Science, St. Louis, Missouri.,Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis-School of Medicine, St. Louis, Missouri
| | - Eric C Leuthardt
- Department of Neuroscience, Washington University in St. Louis-School of Medicine, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University in St. Louis-School of Engineering and Applied Science, St. Louis, Missouri.,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis-School of Engineering and Applied Science, St. Louis, Missouri.,Center for Innovation in Neuroscience and Technology and Washington University in St. Louis-School of Medicine, St. Louis, Missouri.,Brain Laser Center, Washington University in St. Louis-School of Medicine, St. Louis, Missouri.,Department of Neurological Surgery, Washington University in St. Louis-School of Medicine, St. Louis, Missouri
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18
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Steed TC, Treiber JM, Taha B, Engin HB, Carter H, Patel KS, Dale AM, Carter BS, Chen CC. Glioblastomas located in proximity to the subventricular zone (SVZ) exhibited enrichment of gene expression profiles associated with the cancer stem cell state. J Neurooncol 2020; 148:455-462. [PMID: 32556864 DOI: 10.1007/s11060-020-03550-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Conflicting results have been reported in the association between glioblastoma proximity to the subventricular zone (SVZ) and enrichment of cancer stem cell properties. Here, we examined this hypothesis using magnetic resonance (MR) images derived from 217 The Cancer Imaging Archive (TCIA) glioblastoma subjects. METHODS Pre-operative MR images were segmented automatically into contrast enhancing (CE) tumor volumes using Iterative Probabilistic Voxel Labeling (IPVL). Distances were calculated from the centroid of CE tumor volumes to the SVZ and correlated with gene expression profiles of the corresponding glioblastomas. Correlative analyses were performed between SVZ distance, gene expression patterns, and clinical survival. RESULTS Glioblastoma located in proximity to the SVZ showed increased mRNA expression patterns associated with the cancer stem-cell state, including CD133 (P = 0.006). Consistent with the previous observations suggesting that glioblastoma stem cells exhibit increased DNA repair capacity, glioblastomas in proximity to the SVZ also showed increased expression of DNA repair genes, including MGMT (P = 0.018). Reflecting this enhanced DNA repair capacity, the genomes of glioblastomas in SVZ proximity harbored fewer single nucleotide polymorphisms relative to those located distant to the SVZ (P = 0.003). Concordant with the notion that glioblastoma stem cells are more aggressive and refractory to therapy, patients with glioblastoma in proximity to SVZ exhibited poorer progression free and overall survival (P < 0.01). CONCLUSION An unbiased analysis of TCIA suggests that glioblastomas located in proximity to the SVZ exhibited mRNA expression profiles associated with stem cell properties, increased DNA repair capacity, and is associated with poor clinical survival.
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Affiliation(s)
- Tyler C Steed
- Department of Neurosurgery, Emory School of Surgery, Atlanta, GA, USA
| | - Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Birra Taha
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA
| | - H Billur Engin
- Division of Medical Genetics, Department of Medicine, University of California, La Jolla, San Diego, CA, USA
| | - Hannah Carter
- Division of Medical Genetics, Department of Medicine, University of California, La Jolla, San Diego, CA, USA
| | - Kunal S Patel
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Anders M Dale
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, San Diego, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA.
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Dincoglan F, Sager O, Uysal B, Demiral S, Gamsiz H, Gündem E, Elcim Y, Dirican B, Beyzadeoglu M. Evaluatıon of hypofractıonated stereotactıc radıotherapy (HFSRT) to the resectıon cavıty after surgıcal resectıon of braın metastases: A sıngle center experıence. Indian J Cancer 2020; 56:202-206. [PMID: 31389381 DOI: 10.4103/ijc.ijc_345_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTON Adjuvant radiotherapy after surgical resection is used for the treatment of patients with brain metastasis. In this study, we assessed the use of adjuvant hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity for the management of patients with brain metastasis. MATERIALS AND METHODS A total of 28 patients undergoing surgical resection for their brain metastasis were treated using HFSRT to the resection cavity. A total HFSRT dose of 25-30 Gray (Gy) was delivered in 5 consecutive daily fractions. Patients were retrospectively assessed for toxicity, local control, and survival outcomes. Kaplan-Meier method and log-rank test were used for statistical analysis. RESULTS Median planning target volume (PTV) was 27.2 cc (range: 6-76.1 cc). At a median follow-up time of 11 months (range: 2-21 months.), 1-year local control rate was 85.7%, and 1-year distant failure rate was 57.1% (16 patients). Median overall survival was 15 months from HFSRT. Higher recursive partitioning analysis class (P = 0.01) and the presence of extracranial metastases (P = 0.02) were associated with decreased overall survival on statistical analysis. There was no radiation necrosis observed during follow-up. CONCLUSION HFSRT to the resection cavity offers a safe and effective adjuvant treatment for patients undergoing surgical resection of brain metastasis. With comparable local control rates, HFSRT may serve as a viable alternative to whole brain irradiation.
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Affiliation(s)
- Ferrat Dincoglan
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Omer Sager
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Esin Gündem
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
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Turnquist C, Harris BT, Harris CC. Radiation-induced brain injury: current concepts and therapeutic strategies targeting neuroinflammation. Neurooncol Adv 2020; 2:vdaa057. [PMID: 32642709 PMCID: PMC7271559 DOI: 10.1093/noajnl/vdaa057] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Continued improvements in cancer therapies have increased the number of long-term cancer survivors. Radiation therapy remains one of the primary treatment modalities with about 60% of newly diagnosed cancer patients receiving radiation during the course of their disease. While radiation therapy has dramatically improved patient survival in a number of cancer types, the late effects remain a significant factor affecting the quality of life particularly in pediatric patients. Radiation-induced brain injury can result in cognitive dysfunction, including hippocampal-related learning and memory dysfunction that can escalate to dementia. In this article, we review the current understanding of the mechanisms behind radiation-induced brain injury focusing on the role of neuroinflammation and reduced hippocampal neurogenesis. Approaches to prevent or ameliorate treatment-induced side effects are also discussed along with remaining challenges in the field.
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Affiliation(s)
- Casmir Turnquist
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Brent T Harris
- Departments of Neurology and Pathology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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21
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Valencia-Sanchez C, Gorelkin VC, Mrugala MM, Sharma A, Vora SA, Ashman JB, Daniels TB, Halyard MY, Rule WG, Zhang N, Butterfield RJ, Schild SE, Porter AB. Clinical evaluation of fitness to drive in patients with brain metastases. Neurooncol Pract 2019; 6:484-489. [PMID: 31832219 DOI: 10.1093/nop/npz027] [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: 11/12/2022] Open
Abstract
Background Guidelines to provide recommendations about driving restrictions for patients with brain metastases are lacking. We aim to determine whether clinical neurologic examination is sufficient to predict suitability to drive in these patients by comparison with an occupational therapy driving assessment (OTDA). Methods We prospectively evaluated the concordance between neurology assessment of suitability to drive (pass/fail) and OTDA in 41 individuals with brain metastases. Neuro-oncology evaluation included an interview and neurological examination. Participants subsequently underwent OTDA during which a battery of objective measures of visual, cognitive, and motor skills related to driving was administered. Results The mean age of patients who failed OTDA was age 68.9 years vs 59.3 years in the group members who passed (P = .0046). The sensitivity of the neurology assessment to predict driving fitness compared with OTDA was 16.1% and the specificity 90%. The 31 patients who failed OTDA were more likely to fail Vision Coach, Montreal Cognitive Assessment, and Trail Making B tests. Conclusions There was poor association between the assessment of suitability to drive by neurologists and the outcome of the OTDA in patients with brain metastases. Subtle deficits that may impair the ability to drive safely may not be evident on neurologic examination. The positive predictive value was high to predict OTDA failure. Age could be a factor affecting OTDA performance. The results raise questions about the choice of assessments in making recommendations about driving fitness in people with brain metastases. OTDA should be strongly considered in patients with brain metastases who wish to continue driving.
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Affiliation(s)
| | | | | | | | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | | | | | | | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Nan Zhang
- Health Science Research, Mayo Clinic, Scottsdale, AZ
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Qing D, Zhao B, Zhou YC, Zhu HL, Ma DY. Whole-brain radiotherapy plus sequential or simultaneous integrated boost for the treatment of a limited number of brain metastases in non-small cell lung cancer: A single-institution study. Cancer Med 2019; 9:238-246. [PMID: 31749325 PMCID: PMC6943150 DOI: 10.1002/cam4.2696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background To compare the survival outcomes and neurocognitive dysfunction in non‐small cell lung cancer (NSCLC) patients with brain metastases (BM ≤10) treated by whole‐brain radiotherapy (WBRT) with sequential integrated boost (SEB) or simultaneous integrated boost (SIB). Materials Fifty‐two NSCLC patients with a limited number of BMs were retrospectively analyzed. Twenty cases received WBRT+SEB (WBRT: 3 Gy*10 fractions and BMs: 4 Gy*3 fractions; SEB group), and 32 cases received WBRT+SIB (WBRT: 3 Gy*10 fractions and BMs: 4 Gy*10 fractions; SIB group). The survival and mini‐mental state examination (MMSE) scores were compared between the groups. Results The cumulative 1‐, 2‐, and 3‐year survival rates in the SEB vs SIB groups were 60.0% vs 47.8%, 41.1% vs 19.1%, and 27.4% vs 0%, respectively. The median survival times in the SEB and SIB groups were 15 and 10 months, respectively. The difference in survival rate was significant (P = .046). Subgroup analysis revealed that 1‐, 2‐, and 3‐year survival rates and median survival time in the SEB group were significantly superior to those of the SIB group, especially for male patients (age <60 years) with 1‐2 BMs (P < .05). The MMSE score of the SEB group at 3 months after radiation was higher than that of the SIB group (P < .05). Nevertheless, WBRT+SEB required a longer treatment time and greater cost (P < .005). Conclusions WBRT + SEB results in better survival outcomes than WBRT+SIB, especially for male patients (age <60 years) with 1‐2 BMs. WBRT+SEB also appeared to induce less neurocognitive impairment than WBRT+SIB.
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Affiliation(s)
- Dong Qing
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Bin Zhao
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yi-Chen Zhou
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hong-Lei Zhu
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Dai-Yuan Ma
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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23
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Wang W, Sun X, Hui Z. Treatment Optimization for Brain Metastasis from Anaplastic Lymphoma Kinase Rearrangement Non-Small-Cell Lung Cancer. Oncol Res Treat 2019; 42:599-606. [PMID: 31527380 DOI: 10.1159/000502755] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/14/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Brain metastasis is common in non-small-cell lung cancer (NSCLC) with driver gene mutations. Anaplastic lymphoma kinase (ALK) gene rearrangement is one of the common driver mutations in NSCLC. Tyrosine kinase inhibitor (TKI) has been the research hotspot at present. However, there are relatively few studies specified on the treatment of brain metastasis from ALK gene rearrangement NSCLC. The prognosis of these patients, the role of ALK-TKI, and the proper combination model of ALK-TKI with radiotherapy are worth further exploring. This review focuses on new data on the prognosis of ALK-TKI and the proper combination model of ALK-TKI with radiotherapy. SUMMARY According to some retrospective trials, for ALKi-naïve ALK rearrangement NSCLC patients with brain metastasis, crizotinib together with radiotherapy seem to improve intracranial control rate, progression-free survival, and very likely improve overall survival; next-generation ALK-TKIs are now replacing crizotinib as first-line treatment. For patients with central nervous system progression during crizotinib application, combining radiotherapy could improve the local control rate while continuing crizotinib to control systemic disease. Second-/third-generation ALK inhibitors had higher intracranial ORR and DCR even after crizotinib-refractory situations, and they alone had a strong efficacy against intracranial tumors, in which situation radiotherapy might be omitted. Stereotactic radiosurgery (SRS) and whole-brain radiotherapy (WBRT) were both local treatment options for brain metastasis, and the preferred choice was hard to make. ALK resistance is complicated with a wide range of molecular changes, and future studies are needed to solve these problems. Anyway, further and larger prospective studied are worth exploring to offer a confirmed preferred choice of drugs and radiation. Key Messages: Next-generation ALK-TKIs are now replacing crizotinib as first-line treatment in ALKi-naïve ALK rearrangement NSCLC patients with brain metastasis, and they alone might have a strong efficacy against intracranial tumors in crizotinib-refractory situations in which occasion radiotherapy might be omitted. SRS and WBRT are both local treatment options for brain metastasis.
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Affiliation(s)
- Wenhui Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academic of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academic of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academic of Medical Science and Peking Union Medical College, Beijing, China, .,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academic of Medical Science and Peking Union Medical College, Beijing, China,
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24
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Hirshman BR, Wilson B, Ali MA, Proudfoot JA, Koiso T, Nagano O, Carter BS, Serizawa T, Yamamoto M, Chen CC. Superior Prognostic Value of Cumulative Intracranial Tumor Volume Relative to Largest Intracranial Tumor Volume for Stereotactic Radiosurgery-Treated Brain Metastasis Patients. Neurosurgery 2019; 82:473-480. [PMID: 28658940 DOI: 10.1093/neuros/nyx225] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 06/16/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Two intracranial tumor volume variables have been shown to prognosticate survival of stereotactic-radiosurgery-treated brain metastasis patients: the largest intracranial tumor volume (LITV) and the cumulative intracranial tumor volume (CITV). OBJECTIVE To determine whether the prognostic value of the Scored Index for Radiosurgery (SIR) model can be improved by replacing one of its components-LITV-with CITV. METHODS We compared LITV and CITV in terms of their survival prognostication using a series of multivariable models that included known components of the SIR: age, Karnofsky Performance Score, status of extracranial disease, and the number of brain metastases. Models were compared using established statistical measures, including the net reclassification improvement (NRI > 0) and integrated discrimination improvement (IDI). The analysis was performed in 2 independent cohorts, each consisting of ∼3000 patients. RESULTS In both cohorts, CITV was shown to be independently predictive of patient survival. Replacement of LITV with CITV in the SIR model improved the model's ability to predict 1-yr survival. In the first cohort, the CITV model showed an NRI > 0 improvement of 0.2574 (95% confidence interval [CI] 0.1890-0.3257) and IDI of 0.0088 (95% CI 0.0057-0.0119) relative to the LITV model. In the second cohort, the CITV model showed a NRI > 0 of 0.2604 (95% CI 0.1796-0.3411) and IDI of 0.0051 (95% CI 0.0029-0.0073) relative to the LITV model. CONCLUSION After accounting for covariates within the SIR model, CITV offers superior prognostic value relative to LITV for stereotactic radiosurgery-treated brain metastasis patients.
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Affiliation(s)
- Brian R Hirshman
- Department of Neurosurgery, Center for Translational and Applied Neuro-Oncology, University of California, San Diego, La Jolla, California
| | - Bayard Wilson
- Department of Neurosurgery, Center for Translational and Applied Neuro-Oncology, University of California, San Diego, La Jolla, California
| | - Mir Amaan Ali
- Department of Neurosurgery, Center for Translational and Applied Neuro-Oncology, University of California, San Diego, La Jolla, California
| | - James A Proudfoot
- Clinical and Translational Research Institute, University of California San Diego, San Diego, California
| | - Takao Koiso
- Department of Neurosurgery, Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan
| | - Osamu Nagano
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan
| | - Bob S Carter
- Department of Neurosurgery, Center for Translational and Applied Neuro-Oncology, University of California, San Diego, La Jolla, California
| | - Toru Serizawa
- Tsukiji Neurological Clinic, Tokyo Gamma Unit Center, Tokyo, Japan
| | - Masaaki Yamamoto
- Department of Neurosurgery, Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan
| | - Clark C Chen
- Department of Neurosurgery, Center for Translational and Applied Neuro-Oncology, University of California, San Diego, La Jolla, California
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Rassy E, Zanaty M, Azoury F, Pavlidis N. Advances in the management of brain metastases from cancer of unknown primary. Future Oncol 2019; 15:2759-2768. [PMID: 31385529 DOI: 10.2217/fon-2019-0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cancer of unknown primary accounts for 3-5% of all cancers for which an adequate investigation does not identify the primary tumor. The particular subset of brain metastasis in cancer of unknown primary (BMCUP) is a clinical challenge that lacks standardized diagnostic and therapeutic options. It is diagnosed predominantly in male patients in the sixth decade of age with complaints of headache, neurological dysfunction, cognitive and behavioral disturbances and seizures. The therapeutic approach to patients with BMCUP relies on local control and systemic treatment. Surgery or stereotactic radiosurgery and/or whole brain radiation therapy seems to be the cornerstone of the treatment approach to BMCUP. Systemic therapy remains essential as cancers of unknown primary are conceptually metastatic tumors. The benefits of chemotherapy were disappointing whereas those of targeted therapies and immune checkpoint inhibitors remain to be evaluated. In this Review, we address the advances in the diagnosis and treatment of BMCUP.
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Affiliation(s)
- Elie Rassy
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Mario Zanaty
- Department of Neurosurgical Surgery, University of Ioawa, Ioawa City, IA, USA
| | - Fares Azoury
- Department of Radiation Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon
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Cerhan JH, Caine C, Anderson SK, Johnson DR, Lachance DH, Yan E, Brown PD. Preliminary exploration of a computerized cognitive battery and comparison with traditional testing in patients with high-grade glioma. Neurooncol Pract 2019; 6:71-77. [PMID: 31386012 DOI: 10.1093/nop/npy013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Cognitive function is an important outcome measure in many brain tumor clinical trials, and investigators are interested in employing the most efficient methods of cognitive assessment for this purpose. Computerized testing can be appealing because of the perceived ease of use and electronic data generated. Traditional tests may have the advantage of accumulated validity evidence and comparability across historic trials. Methods We evaluated feasibility of a Cogstate battery in 39 patients with high-grade glioma, and compared it with a commonly used paper-and-pencil battery. Results Both batteries were well tolerated and rated equally likeable. Correlations between the batteries were low to low-moderate. More patients showed impairment at baseline and decline across trials on traditional tests. Conclusions Both batteries were well tolerated, but the most complicated tasks (from both batteries) could not be completed by all subjects. Preliminary validity evidence for the Cogstate tasks was mixed, but a larger sample is needed.
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Affiliation(s)
- Jane H Cerhan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Chip Caine
- Intermountain Medical Center, Neurosciences Institute, Intermountain Medical Center, Murray, Utah.,University of Phoenix, Utah Campus
| | - S Keith Anderson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Elizabeth Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Alattar AA, Bartek J, Chiang VL, Mohammadi AM, Barnett GH, Sloan A, Chen CC. Stereotactic Laser Ablation as Treatment of Brain Metastases Recurring after Stereotactic Radiosurgery: A Systematic Literature Review. World Neurosurg 2019; 128:134-142. [DOI: 10.1016/j.wneu.2019.04.200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022]
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28
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Huynh-Le MP, Karunamuni R, Moiseenko V, Farid N, McDonald CR, Hattangadi-Gluth JA, Seibert TM. Dose-dependent atrophy of the amygdala after radiotherapy. Radiother Oncol 2019; 136:44-49. [PMID: 31015128 PMCID: PMC7041546 DOI: 10.1016/j.radonc.2019.03.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The amygdalae are deep brain nuclei critical to emotional processing and the creation and storage of memory. It is not known whether the amygdalae are affected by brain radiotherapy (RT). We sought to quantify dose-dependent amygdala change one year after brain RT. MATERIALS AND METHODS 52 patients with primary brain tumors were retrospectively identified. Study patients underwent high-resolution, volumetric magnetic resonance imaging before RT and 1 year afterward. Images were processed using FDA-cleared software for automated segmentation of amygdala volume. Tumor, surgical changes, and segmentation errors were manually censored. Mean amygdala RT dose was tested for correlation with amygdala volume change 1 year after RT via the Pearson correlation coefficient. A linear mixed-effects model was constructed to evaluate potential predictors of amygdala volume change, including age, tumor hemisphere, sex, seizure history, and bevacizumab treatment during the study period. As 51 of 52 patients received chemotherapy, possible chemotherapy effects could not be studied. A two-tailed p-value <0.05 was considered statistically significant. RESULTS Mean amygdala RT dose (r = -0.28, p = 0.01) was significantly correlated with volume loss. On multivariable analysis, the only significant predictor of amygdala atrophy was radiation dose. The final linear mixed-effects model estimated amygdala volume loss of 0.17% for every 1 Gy increase in mean amygdala RT dose (p = 0.008). CONCLUSIONS The amygdala demonstrates dose-dependent atrophy one year after radiotherapy for brain tumors. Amygdala atrophy may mediate neuropsychological effects seen after brain RT.
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Affiliation(s)
- Minh-Phuong Huynh-Le
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States
| | - Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States; Department of Bioengineering, University of California San Diego, La Jolla, CA, United States.
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Izard MA, Moutrie V, Rogers JM, Beath K, Grace M, Karle B, Ho A, Fuller JW. Volume not number of metastases: Gamma Knife radiosurgery management of intracranial lesions from an Australian perspective. Radiother Oncol 2019; 133:43-49. [DOI: 10.1016/j.radonc.2018.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/31/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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30
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Xing P, Mu Y, Hao X, Wang Y, Li J. Data from real world to evaluate the efficacy of osimertinib in non-small cell lung cancer patients with central nervous system metastasis. Clin Transl Oncol 2019; 21:1424-1431. [DOI: 10.1007/s12094-019-02071-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/23/2019] [Indexed: 12/25/2022]
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Jiao X, Yu Y, Meng J, He M, Zhang CJ, Geng W, Ding B, Wang Z, Ding X. Dual-targeting and microenvironment-responsive micelles as a gene delivery system to improve the sensitivity of glioma to radiotherapy. Acta Pharm Sin B 2019; 9:381-396. [PMID: 30972284 PMCID: PMC6437633 DOI: 10.1016/j.apsb.2018.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
Dbait is a small double-stranded DNA molecule that has been utilized as a radiosensitizer to enhance the sensitivity of glioma to radiotherapy (RT). However, there is no effective drug delivery system to effectively overcome the blood-brain barrier (BBB). The aim of this study was to develop a gene delivery system by using the BBB and glioma dual-targeting and microenvironment-responsive micelles (ch-Kn(s-s)R8-An) to deliver Dbait into glioma for RT. Angiopep-2 can target the low-density lipoprotein receptor-related protein-1 (LRP1) that is overexpressed on brain capillary endothelial cells (BCECs) and glioma cells. In particular, due to upregulated matrix metalloproteinase 2 (MMP-2) in the tumor microenvironment, we utilized MMP-2-responsive peptides as the enzymatically degradable linkers to conjugate angiopep-2. The results showed that ch-Kn(s-s)R8-An micelles maintained a reasonable size (80-160 nm) with a moderate distribution and a decreased mean diameter from the cross-linking as well as exhibited low critical micelle concentration (CMC) with positive surface charge, ranging from 15 to 40 mV. The ch-K5(s-s)R8-An/pEGFP showed high gene transfection efficiency in vitro, improved uptake in glioma cells and good biocompatibility in vitro and in vivo. In addition, the combination of ch-K5(s-s)R8-An/Dbait with RT significantly inhibited the growth of U251 cells in vitro. Thus, ch-K5(s-s)R8-An/Dbait may prove to be a promising gene delivery system to target glioma and enhance the efficacy of RT on U251 cells.
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Key Words
- ATCC, American Type Culture Collection
- Arg, arginine
- BBB, blood–brain barrier
- BBTB, blood—brain tumor barriers
- CMC, critical micelle concentration
- Cell-penetrating peptides
- DTSSP, 3,3′-dithiobis(sulfosuccinimidylpropionate)
- DTT, dithiothreitol
- FBS, fetal bovine serum
- GBM, glioblastoma multiforme
- GSH, glutathione
- Gene delivery
- Glioma-targeting
- KnR8, cholesterol-polylysine-polyarginine peptide, n = 3, 5, 7
- Lys, lysine
- MMP-2, matrix metalloproteinase 2
- MWCO, molecular weight cutoff
- Microenvironment-responsive micelles
- PDI, polydispersity index
- PE, plating efficiency
- PEI, polyethylenimine
- RT, radiotherapy
- Radiosensitizer
- ch-Kn(s-s)R8-An, the disulfide cross-linked cholesterol-polylysine-polyarginine peptide core-shell polymer micelles modified with angiopep-2, n = 3, 5, 7
- ch-KnR8-An, the non-cross-linked cholesterol-polylysine-polyarginine peptide core-shell polymer micelles modified with angiopep-2, n = 3, 5, 7
- pDNA, plasmid DNA
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Affiliation(s)
- Xiuxiu Jiao
- Department of Pharmaceutics, Shanghai General Hospital, Shanghai Jiao Tong University of Medicine, Shanghai 200080, China
| | - Yuan Yu
- Department of Pharmaceutical Sciences, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jianxia Meng
- Department of Pharmacy, Changhai Hospital, Second Military Medical University, Shanghai 200082, China
| | - Mei He
- Department of Pharmaceutics, Shanghai General Hospital, Shanghai Jiao Tong University of Medicine, Shanghai 200080, China
| | - Charles Jian Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91768, USA
| | - Wenqian Geng
- Department of Pharmaceutics, Shanghai General Hospital, Shanghai Jiao Tong University of Medicine, Shanghai 200080, China
| | - Baoyue Ding
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing 314000, China
| | - Zhuo Wang
- Department of Pharmacy, Changhai Hospital, Second Military Medical University, Shanghai 200082, China
| | - Xueying Ding
- Department of Pharmaceutics, Shanghai General Hospital, Shanghai Jiao Tong University of Medicine, Shanghai 200080, China
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Costa MS, Holderbaum CS, Wagner GP. Avaliação Neuropsicológica em Pacientes com Tumores Cerebrais: revisão sistemática da literatura. REVISTA DE PSICOLOGIA DA IMED 2018. [DOI: 10.18256/2175-5027.2018.v10i2.2676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Os tumores cerebrais (TC) são causados pelo crescimento anormal de células. As consequências dos TC podem envolver prejuízos físicos, cognitivos e emocionais. Objetiva-se identificar e descrever os prejuízos cognitivos associados aos TC, através de uma revisão sistemática da literatura. As buscas realizaram-se nas bases de dados internacionais PubMed/MEDLINE, LILACS, e SCOPUS, incluindo abstracts de artigos publicados de 2006 a 2016. Encontrou-se 501 artigos desses, 31 cumpriram os critérios de inclusão. Os TC, representam 5% das neoplasias, sendo alguns mais agressivos que outros. Apresenta-se como sintomas severos: déficits cognitivos, motores. A avaliação neuropsicológica auxilia na identificação de possíveis alterações cognitivas e no acompanhamento dos efeitos do tratamento, contribuindo para melhor qualidade de vida desses pacientes. Os resultados encontrados indicaram as Escalas Wechsler de Inteligência; Matrizes Progressivas de Raven, Figuras Complexas de Rey, Teste de Retenção Visual de Benton, e Token Test como os mais utilizados, e que evidenciaram como prejuízos os envolvendo a memória, a atenção e funções executivas. A localização mais frequente destes TC eram as regiões frontais e temporais e os gliomas o tipo de tumor mais investigado.
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Gempt J, Bette S, Albertshauser J, Cammardella JH, Gradtke C, Wiestler B, Schirmer L, Ryang YM, Meyer B, Ringel F. Personality Traits in Patients with Neuroepithelial Tumors - A Prospective Study. Sci Rep 2018; 8:17055. [PMID: 30451871 PMCID: PMC6243000 DOI: 10.1038/s41598-018-34980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/28/2018] [Indexed: 11/09/2022] Open
Abstract
Aim of this study was to analyze personality traits in patients with neuroepithelial brain tumors. Personality alteration is a common feature in brain tumor patients, but not much is known about associations between specific personality changes and brain tumors. We assessed potential factors influencing personality such as tumor location, tumor grade and tumor volume. Mini-mental state examination (MMSE), Beck's Depression Inventory II (BDI-II), and the NEO Five-Factor Inventory (NEO-FFI) for the five factors of personality were acquired. Patients had lower scores regarding the factor openness and higher scores regarding the BDI-II compared to the norm population. No significant influencing factors (tumor entity, location) were found regarding personality traits. Neuroticism was associated with depression, whereas extraversion showed an opposed association. Patients with intrinsic brain tumors have differences in personality traits compared to the control population, with an emphasis on the factor openness. No significant confounding factors like tumor grade, entity, or location were found for personality traits.
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Affiliation(s)
- Jens Gempt
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany.
| | - Stefanie Bette
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jennifer Albertshauser
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jasmin Hernandez Cammardella
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Corinna Gradtke
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Benedikt Wiestler
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Lucas Schirmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neurology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
| | - Yu-Mi Ryang
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Bernhard Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Florian Ringel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
- Neurochirurgische Klinik und Poliklinik, Johannes Gutenberg-Universität Mainz, Langenbeckstraße, Mainz, 155131, Germany
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Integration of Diffusion Magnetic Resonance Tractography into tomotherapy radiation treatment planning for high-grade gliomas. Phys Med 2018; 55:127-134. [DOI: 10.1016/j.ejmp.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/23/2018] [Accepted: 10/02/2018] [Indexed: 01/23/2023] Open
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Schimmel WC, Gehring K, Eekers DB, Hanssens PE, Sitskoorn MM. Cognitive effects of stereotactic radiosurgery in adult patients with brain metastases: A systematic review. Adv Radiat Oncol 2018; 3:568-581. [PMID: 30370357 PMCID: PMC6200877 DOI: 10.1016/j.adro.2018.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Stereotactic radiation surgery (SRS) is increasingly applied in patients with brain metastases (BM) and is expected to have fewer adverse effects on cognitive functioning than whole brain radiation therapy (WBRT). Patients with BM are often confronted with a relatively short life expectancy, and the prevention or delay of cognitive decline to maintain quality of life is a clinically and highly relevant treatment goal. This review systematically and specifically evaluates the current literature on the cognitive effects of SRS in patients with BM. METHODS AND MATERIALS Published trials on SRS alone or in combination with WBRT, including objective assessment of cognitive functioning, were identified through a systematic search of the PubMed database up to March 2018. RESULTS Of the 241 records screened, 14 studies matched the selection criteria: 2 pilot studies, 7 single-group/observational trials (1 study update), and 5 randomized trials (1 secondary analysis). CONCLUSIONS In general, the results show little to no objective cognitive decline up to 4 months after SRS compared with WBRT. However, most trials suffered from methodologic limitations that hindered reliable conclusions. Most importantly, few studies investigated the specific cognitive effects of SRS alone or versus WBRT. Furthermore, disentangling the cognitive effects of SRS from the effects of the disease itself and from the effects of other treatments remains very difficult. By presenting this comprehensive review, we aim to encourage researchers to probe deeper into this area and to do so in a standardized and methodologically optimal manner. The ultimate objective of this line of research is to inform both doctors and patients more precisely about the cognitive effects they can expect from treatment. This study is expected to improve the quality of decision-making and maximize clinical outcomes for each individual patient.
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Affiliation(s)
- Wietske C.M. Schimmel
- Gamma Knife Center, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Karin Gehring
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Daniëlle B.P. Eekers
- Department of Radiation Oncology, GROW–School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - Patrick E.J. Hanssens
- Gamma Knife Center, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Margriet M. Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
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Harary M, Kavouridis VK, Thakuria M, Smith TR. Predictors of survival in neurometastatic Merkel cell carcinoma. Eur J Cancer 2018; 101:152-159. [PMID: 30071443 DOI: 10.1016/j.ejca.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous malignancy of neuroendocrine origin, with about 30 cases of brain metastasis (BM) reported in the literature. Historically, the treatment of neurometastatic MCC has largely included chemotherapy and radiotherapy. The aim was to investigate predictors of overall survival (OS) in neurometastatic MCC. METHODS In this retrospective study, we surveyed institutional databases and conducted a systematic review of the literature to identify cases reporting on management of distant MCC BM. A pooled survival analysis was performed on the institutional and literature cases to assess predictors of OS. RESULTS Forty cases were included for analysis, describing operative [14] and non-operative [26] management. Median time to central nervous system involvement was 17.0-mos (interquartile range 10.5-26.5), and most patients had a single BM (62.5%). Management of intracranial disease included radiotherapy (82.5%), systemic therapy (59.5%) and surgical resection (35%). Operative management was associated with a lower intracranial burden of disease (BoD), but similar systemic BoD. Both neurosurgery (hazard ratio [HR] 0.18, 95% confidence interval [CI]: 0.06-0.54, p = 0.002), having RT (HR 0.37, 95% CI: 0.14:0.93, p = 0.04) and having a single BM (extensive intracranial BoD: HR 2.51, 95% CI: 1.12-5.6, p = 0.03) conferred an OS benefit on risk-unadjusted analysis. Only, neurosurgical resection was an independent predictor of OS (HR 0.12, 95% CI: 0.03-0.49, p = 0.003), controlling for age, BoD and radiotherapy. CONCLUSIONS Resection of MCC BM may confer a survival benefit given appropriate patient selection. Prospective investigation of multimodal management of neurometastatic MCC is warranted, especially given the promise of new immunotherapy agents in treating MCC.
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Affiliation(s)
- Maya Harary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vasileios K Kavouridis
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Manisha Thakuria
- Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Knuutinen O, Kuitunen H, Alahuhta S, Isokangas JM, Sonkajärvi E, Turpeenniemi-Hujanen T, Kuittinen O. Case Report: Chemotherapy in Conjunction With Blood-Brain Barrier Disruption for a Patient With Germ Cell Tumor With Multiple Brain Metastases. Clin Genitourin Cancer 2018; 16:e993-e996. [PMID: 29844007 DOI: 10.1016/j.clgc.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Oula Knuutinen
- Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland.
| | - Hanne Kuitunen
- Department of Oncology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Juha-Matti Isokangas
- Department of Diagnostic Radiology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Eila Sonkajärvi
- Department of Anaesthesiology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Taina Turpeenniemi-Hujanen
- Department of Oncology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Outi Kuittinen
- Department of Oncology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
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38
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Yomo S, Oda K. Impacts of EGFR-mutation status and EGFR-TKI on the efficacy of stereotactic radiosurgery for brain metastases from non-small cell lung adenocarcinoma: A retrospective analysis of 133 consecutive patients. Lung Cancer 2018; 119:120-126. [DOI: 10.1016/j.lungcan.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
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Watve A, Gupta M, Khushu S, Rana P. Longitudinal changes in gray matter regions after cranial radiation and comparative analysis with whole body radiation: a DTI study. Int J Radiat Biol 2018; 94:532-541. [PMID: 29659316 DOI: 10.1080/09553002.2018.1466064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Radiation-induced white matter changes are well known and vastly studied. However, radiation-induced gray matter alterations are still a research question. In the present study, these changes were assessed in a longitudinal manner using Diffusion Tensor Imaging (DTI) and further compared for cranial and whole body radiation exposure. MATERIALS AND METHODS Male mice (C57BL/6) were irradiated with cranial or whole body radiation followed by DTI study at 7T animal MRI system during predose, subacute and early delayed phases of radiation sickness. Fractional anisotropy (FA) and mean diffusivity (MD) values were obtained from brain's gray matter regions. RESULTS Decreased FA with increased MD was observed prominently in animals exposed to cranial radiation showing most changes at 8 months post irradiation. However, whole body radiation induced FA changes were mostly observed at 1 month post irradiation as compared to controls. CONCLUSIONS The differential response after whole body and cranial irradiation observed in the study depicts that radiation exposure of 5 Gy could induce permanent alterations in gray matter regions prominently as observed in Caudoputamen region at all the time points. Thus, our study has bolstered the role of DTI to probe microstructural changes in gray matter regions of brain after radiation exposure.
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Affiliation(s)
- Apurva Watve
- a NMR Research Centre , Institute of Nuclear Medicine and Allied Sciences , Delhi , India
| | - Mamta Gupta
- a NMR Research Centre , Institute of Nuclear Medicine and Allied Sciences , Delhi , India
| | - Subash Khushu
- a NMR Research Centre , Institute of Nuclear Medicine and Allied Sciences , Delhi , India
| | - Poonam Rana
- a NMR Research Centre , Institute of Nuclear Medicine and Allied Sciences , Delhi , India
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40
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Sleurs C, Lemiere J, Christiaens D, Billiet T, Peeters R, Sunaert S, Uyttebroeck A, Deprez S. Advanced MR diffusion imaging and chemotherapy-related changes in cerebral white matter microstructure of survivors of childhood bone and soft tissue sarcoma? Hum Brain Mapp 2018; 39:3375-3387. [PMID: 29675944 DOI: 10.1002/hbm.24082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
With the increase of survival rates of pediatric cancer patients, the number of children facing potential cognitive sequelae has grown. Previous adult studies suggest that white matter (WM) microstructural changes may contribute to cognitive impairment. This study aims to investigate WM microstructure in childhood bone and soft tissue sarcoma. Differences in (micro-)structure can be investigated using diffusion MRI (dMRI). The typically used diffusion tensor model (DTI) assumes Gaussian diffusion, and lacks information about fiber populations. In this study, we compare WM structure of childhood bone and soft tissue sarcoma survivors (n = 34) and matched controls (n = 34), combining typical and advanced voxel-based models (DTI and NODDI model, respectively), as well as recently developed fixel-based models (for estimations of intra-voxel differences, apparent fiber density [AFD] and fiber cross-section [FC]). Parameters with significant findings were compared between treatments, and correlated with subscales of the WAIS-IV intelligence test, age at diagnosis, age at assessment and time since diagnosis. We encountered extensive regions showing lower fractional anisotropy, overlapping with both significant NODDI parameters and fixel-based parameters. In contrast to these diffuse differences, the fixel-based measure of AFD was reduced in the cingulum and corpus callosum only. Furthermore, AFD of the corpus callosum was significantly predicted by chemotherapy treatment and correlated positively with time since diagnosis, visual puzzles and similarities task scores. This study suggests altered WM structure of childhood bone and soft tissue sarcoma survivors. We conclude global chemotherapy-related changes, with particular vulnerability of centrally located WM bundles. Finally, such differences could potentially recover after treatment.
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Affiliation(s)
- Charlotte Sleurs
- Department of Pediatrics, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Oncology, UZ Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatrics, University Hospitals Leuven, UZ Leuven, Belgium
| | - Daan Christiaens
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Thibo Billiet
- Imaging Biomarker Experts, Icometrix, Leuven, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Imaging and Pathology, UZ Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatrics, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Oncology, UZ Leuven, Belgium
| | - Sabine Deprez
- Department of Radiology, University Hospitals Leuven, UZ Leuven, Belgium.,Department of Imaging and Pathology, UZ Leuven, Belgium
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Murzin VL, Woods K, Moiseenko V, Karunamuni R, Tringale KR, Seibert TM, Connor MJ, Simpson DR, Sheng K, Hattangadi-Gluth JA. 4π plan optimization for cortical-sparing brain radiotherapy. Radiother Oncol 2018; 127:128-135. [PMID: 29519628 PMCID: PMC6084493 DOI: 10.1016/j.radonc.2018.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Incidental irradiation of normal brain tissue during radiotherapy is linked to cognitive decline, and may be mediated by damage to healthy cortex. Non-coplanar techniques may be used for cortical sparing. We compared normal brain sparing and probability of cortical atrophy using 4π radiation therapy planning vs. standard fixed gantry intensity-modulated radiotherapy (IMRT). MATERIAL AND METHODS Plans from previously irradiated brain tumor patients ("original IMRT", n = 13) were re-planned to spare cortex using both 4π optimization ("4π") and IMRT optimization ("optimized IMRT"). Homogeneity index (HI), gradient measure, doses to cortex and white matter (excluding tumor), brainstem, optics, and hippocampus were compared with matching PTV coverage. Probability of three grades of post-treatment cortical atrophy was modeled based on previously established dose response curves. RESULTS With matching PTV coverage, 4π significantly improved HI by 27% (p = 0.005) and gradient measure by 8% (p = 0.001) compared with optimized IMRT. 4π optimization reduced mean and equivalent uniform doses (EUD) to all standard OARs, with 14-15% reduction in hippocampal EUD (p ≤ 0.003) compared with the other two plans. 4π significantly reduced dose to fractional cortical volumes (V50, V40 and V30) compared with the original IMRT plans, and reduced cortical V30 by 7% (p = 0.008) compared with optimized IMRT. White matter EUD, mean dose, and fractional volumes V50, V40 and V30 were also significantly lower with 4π (p ≤ 0.001). With 4π, probability of grade 1, 2 and 3 cortical atrophy decreased by 12%, 21% and 26% compared with original IMRT and by 8%, 14% and 3% compared with optimized IMRT, respectively (p ≤ 0.001). CONCLUSIONS 4π radiotherapy significantly improved cortical sparing and reduced doses to standard brain OARs, white matter, and the hippocampus. This was achieved with superior PTV dose homogeneity. Such sparing could reduce the probability of cortical atrophy that may lead to cognitive decline.
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Affiliation(s)
- Vyacheslav L Murzin
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Kaley Woods
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Kathryn R Tringale
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Michael J Connor
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Daniel R Simpson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States.
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Macchia G, Deodato F, Cilla S, Cammelli S, Guido A, Ferioli M, Siepe G, Valentini V, Morganti AG, Ferrandina G. Volumetric modulated arc therapy for treatment of solid tumors: current insights. Onco Targets Ther 2017; 10:3755-3772. [PMID: 28794640 PMCID: PMC5538686 DOI: 10.2147/ott.s113119] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Aim This article discusses the current use of volumetric modulated arc therapy (VMAT) techniques in clinical practice and reviews the available data from clinical outcome studies in different clinical settings. An overview of available literature about clinical outcomes with VMAT stereotactic/radiosurgical treatment is also reported. Materials and methods All published manuscripts reporting the use of VMAT in a clinical setting from 2009 to November 2016 were identified. The search was carried out in December 2016 using the National Library of Medicine (PubMed/Medline). The following words were searched: “volumetric arc therapy”[All Fields] OR “vmat”[All Fields] OR “rapidarc”[All Fields], AND “radiotherapy”[All Fields] AND “Clinical Trial”[All Fields]. Results Overall, 37 studies (21 prospective and 16 retrospective) fulfilling inclusion criteria and thus included in the review evaluated 2,029 patients treated with VMAT; of these patients, ~30.8% had genitourinary (GU) tumors (81% prostate, 19% endometrial), 26.2% head-and-neck cancer (H&NC), 13.9% oligometastases, 11.2% had anorectal cancer, 10.6% thoracic neoplasms (81% breast, 19% lung), and 7.0% brain metastases (BMs). Six different clinical scenarios for VMAT use were identified: 1) BMs, 2) H&NC, 3) thoracic neoplasms, 4) GU cancer, 5) anorectal tumor, and 6) stereotactic body radiation therapy (SBRT) performed by VMAT technique in the oligometastatic patient setting. Conclusion The literature addressing the clinical appropriateness of VMAT is scarce. Current literature suggests that VMAT, especially when used as simultaneous integrated boost or SBRT strategy, is an effective safe modality for all cancer types.
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Affiliation(s)
| | | | - Savino Cilla
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of the Sacred Heart, Campobasso
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Alessandra Guido
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Martina Ferioli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Giambattista Siepe
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Vincenzo Valentini
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome
| | - Alessio Giuseppe Morganti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna
| | - Gabriella Ferrandina
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome.,Department of Health Sciences and Medicine, University of Molise, Campobasso, Italy
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Survival Patterns of 5750 Stereotactic Radiosurgery-Treated Patients with Brain Metastasis as a Function of the Number of Lesions. World Neurosurg 2017; 107:944-951.e1. [PMID: 28735121 DOI: 10.1016/j.wneu.2017.07.062] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of brain metastases (BMs) plays an important role in the decision between stereotactic radiosurgery (SRS) and whole-brain radiation therapy. METHODS We analyzed the survival of 5750 SRS-treated patients with BM as a function of BM number. Survival analyses were performed with Kaplan-Meier analysis as well as univariate and multivariate Cox proportional hazards models. RESULTS Patients with BMs were first categorized as those with 1, 2-4, and 5-10 BMs based on the scheme proposed by Yamamoto et al. (Lancet Oncology 2014). Median overall survival for patients with 1 BM was superior to those with 2-4 BMs (7.1 months vs. 6.4 months, P = 0.009), and survival of patients with 2-4 BMs did not differ from those with 5-10 BMs (6.4 months vs. 6.3 months, P = 0.170). The median survival of patients with >10 BMs was lower than those with 2-10 BMs (6.3 months vs. 5.5 months, P = 0.025). In a multivariate model that accounted for age, Karnofsky Performance Score, systemic disease status, tumor histology, and cumulative intracranial tumor volume, we observed a ∼10% increase in hazard of death when comparing patients with 1 versus 2-10 BMs (P < 0.001) or 10 versus >10 BMs (P < 0.001). When BM number was modeled as a continuous variable rather than using the classification by Yamamoto et al., we observed a step-wise 4% increase in the hazard of death for every increment of 6-7 BM (P < 0.001). CONCLUSIONS The contribution of BM number to overall survival is modest and should be considered as one of the many variables considered in the decision between SRS and whole-brain radiation therapy.
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Carroll KT, Hirshman B, Ali MA, Alattar AA, Brandel MG, Lochte B, Lanman T, Carter B, Chen CC. Management and Survival Patterns of Patients with Gliomatosis Cerebri: A SEER-Based Analysis. World Neurosurg 2017; 103:186-193. [DOI: 10.1016/j.wneu.2017.03.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 01/27/2023]
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Bahrami N, Seibert TM, Karunamuni R, Bartsch H, Krishnan A, Farid N, Hattangadi-Gluth JA, McDonald CR. Altered Network Topology in Patients with Primary Brain Tumors After Fractionated Radiotherapy. Brain Connect 2017; 7:299-308. [PMID: 28486817 PMCID: PMC5510052 DOI: 10.1089/brain.2017.0494] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Radiation therapy (RT) is a critical treatment modality for patients with brain tumors, although it can cause adverse effects. Recent data suggest that brain RT is associated with dose-dependent cortical atrophy, which could disrupt neocortical networks. This study examines whether brain RT affects structural network properties in brain tumor patients. We applied graph theory to MRI-derived cortical thickness estimates of 54 brain tumor patients before and after RT. Cortical surfaces were parcellated into 68 regions and correlation matrices were created for patients pre- and post-RT. Significant changes in graph network properties were tested using nonparametric permutation tests. Linear regressions were conducted to measure the association between dose and changes in nodal network connectivity. Increases in transitivity, modularity, and global efficiency (n = 54, p < 0.0001) were all observed in patients post-RT. Decreases in local efficiency (n = 54, p = 0.007) and clustering coefficient (n = 54, p = 0.005) were seen in regions receiving higher RT doses, including the inferior parietal lobule and rostral anterior cingulate. These findings demonstrate alterations in global and local network topology following RT, characterized by increased segregation of brain regions critical to cognition. These pathological network changes may contribute to the late delayed cognitive impairments observed in many patients following brain RT.
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Affiliation(s)
- Naeim Bahrami
- Center for Multimodal Imaging and Genetics (CMIG), University of California, San Diego, La Jolla, California
- Department of Psychiatry, University of California, San Diego, La Jolla, California
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Tyler M. Seibert
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California
- Department of Radiation Medicine, University of California, San Diego, La Jolla, California
| | - Roshan Karunamuni
- Department of Radiation Medicine, University of California, San Diego, La Jolla, California
| | - Hauke Bartsch
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - AnithaPriya Krishnan
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California
| | - Nikdokht Farid
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California
- Department of Radiology, University of California, San Diego, La Jolla, California
| | | | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics (CMIG), University of California, San Diego, La Jolla, California
- Department of Psychiatry, University of California, San Diego, La Jolla, California
- Multimodal Imaging Laboratory, University of California, San Diego, La Jolla, California
- Department of Radiation Medicine, University of California, San Diego, La Jolla, California
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Paix A, Antoni D, Adeduntan R, Noël G. Stereotactic radiation therapy of brain metastases from colorectal cancer: A single institution cohort. Cancer Radiother 2017; 21:199-204. [PMID: 28499660 DOI: 10.1016/j.canrad.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE The brain remains an uncommon site of colorectal cancer metastases. Due to the improvement of overall colorectal cancer patient survival, the incidence of brain metastases will likely rise. We report the efficacy and safety of hypofractionnated stereotactic radiation therapy and stereotactic radiosurgery, and its role in colorectal cancer brain metastasis management. METHODS AND MATERIAL Between June 2010 and December 2014, fifteen consecutive patients received hypofractionnated stereotactic radiation therapy or stereotactic radiosurgery as first local therapy or following surgical removal for colorectal cancer brain metastases. The primary endpoint was overall survival. Secondary endpoints were brain progression free survival, in field control rates and safety. RESULTS Median follow-up was 41 months (95% confidence interval [CI]: [8.9-73.1 months]), median overall survival was 8 months (95% CI [4.7-11.3 months]), and median brain progression-free survival was 5 months (95% CI [3.9-6.1 months]). Five in field recurrences were observed, which makes a control rate per metastases at 6 and 12 months of 77.8% (95% CI [74.34%-81.26%]), 51.9% (95% CI [44.21%-59.59%]) respectively. Over the 19 treatment sequences, five in field recurences were observed: 6, 12 and 18 months control rate per treatment sequence were 93.3% (95% CI [90.42%-96.18%]), 68.1% (95% CI [62.03%-74.17%]) and 45.4% (95% CI [36.14%-54.66%]) respectively. Immediate tolerance was good with no toxicity grade III or more. Long-term toxicity included two radionecrosis among which, one was symptomatic. DISCUSSION The results of this retrospective analysis suggest that hypofractionnated stereotactic radiation therapy and stereotactic radiosurgery are effective and safe treatment modalities for single and multiple small brain metastases from colorectal cancer. However, results need to be confirmed by multicenter, collected data.
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Affiliation(s)
- A Paix
- Radiotherapy Department, centre Paul-Strauss, 3, rue de la porte-de-l'hôpital, BP 42, 67065 Strasbourg cedex, France
| | - D Antoni
- Radiotherapy Department, centre Paul-Strauss, 3, rue de la porte-de-l'hôpital, BP 42, 67065 Strasbourg cedex, France; Radiobiology Laboratory EA 3430, Federation of Translational Medicine in Strasbourg (FMTS), Strasbourg University, 3, rue de la porte de l'hôpital, 67062 Strasbourg, France
| | - R Adeduntan
- University of Virginia School of Medicine, 200 Jeannette Lancaster Way, 22903 Charlottesville, VA, USA
| | - G Noël
- Radiotherapy Department, centre Paul-Strauss, 3, rue de la porte-de-l'hôpital, BP 42, 67065 Strasbourg cedex, France; Radiobiology Laboratory EA 3430, Federation of Translational Medicine in Strasbourg (FMTS), Strasbourg University, 3, rue de la porte de l'hôpital, 67062 Strasbourg, France.
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Brandel MG, Alattar AA, Hirshman BR, Dong X, Carroll KT, Ali MA, Carter BS, Chen CC. Survival trends of oligodendroglial tumor patients and associated clinical practice patterns: a SEER-based analysis. J Neurooncol 2017; 133:173-181. [DOI: 10.1007/s11060-017-2430-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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Seibert TM, Karunamuni R, Kaifi S, Burkeen J, Connor M, Krishnan AP, White NS, Farid N, Bartsch H, Murzin V, Nguyen TT, Moiseenko V, Brewer JB, McDonald CR, Dale AM, Hattangadi-Gluth JA. Cerebral Cortex Regions Selectively Vulnerable to Radiation Dose-Dependent Atrophy. Int J Radiat Oncol Biol Phys 2017; 97:910-918. [PMID: 28333012 PMCID: PMC5403140 DOI: 10.1016/j.ijrobp.2017.01.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/08/2016] [Accepted: 01/01/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE AND OBJECTIVES Neurologic deficits after brain radiation therapy (RT) typically involve decline in higher-order cognitive functions such as attention and memory rather than sensory defects or paralysis. We sought to determine whether areas of the cortex critical to cognition are selectively vulnerable to radiation dose-dependent atrophy. METHODS AND MATERIALS We measured change in cortical thickness in 54 primary brain tumor patients who underwent fractionated, partial brain RT. The study patients underwent high-resolution, volumetric magnetic resonance imaging (T1-weighted; T2 fluid-attenuated inversion recovery, FLAIR) before RT and 1 year afterward. Semiautomated software was used to segment anatomic regions of the cerebral cortex for each patient. Cortical thickness was measured for each region before RT and 1 year afterward. Two higher-order cortical regions of interest (ROIs) were tested for association between radiation dose and cortical thinning: entorhinal (memory) and inferior parietal (attention/memory). For comparison, 2 primary cortex ROIs were also tested: pericalcarine (vision) and paracentral lobule (somatosensory/motor). Linear mixed-effects analyses were used to test all other cortical regions for significant radiation dose-dependent thickness change. Statistical significance was set at α = 0.05 using 2-tailed tests. RESULTS Cortical atrophy was significantly associated with radiation dose in the entorhinal (P=.01) and inferior parietal ROIs (P=.02). By contrast, no significant radiation dose-dependent effect was found in the primary cortex ROIs (pericalcarine and paracentral lobule). In the whole-cortex analysis, 9 regions showed significant radiation dose-dependent atrophy, including areas responsible for memory, attention, and executive function (P≤.002). CONCLUSIONS Areas of cerebral cortex important for higher-order cognition may be most vulnerable to radiation-related atrophy. This is consistent with clinical observations that brain radiation patients experience deficits in domains of memory, executive function, and attention. Correlations of regional cortical atrophy with domain-specific cognitive functioning in prospective trials are warranted.
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Affiliation(s)
- Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Samar Kaifi
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Jeffrey Burkeen
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Michael Connor
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | | | - Nathan S White
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Hauke Bartsch
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Vyacheslav Murzin
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Tanya T Nguyen
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - James B Brewer
- Department of Radiology, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California; Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, California; Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California, San Diego, La Jolla, California
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.
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Karunamuni RA, White NS, McDonald CR, Connor M, Pettersson N, Seibert TM, Kuperman J, Farid N, Moiseenko V, Dale AM, Hattangadi-Gluth JA. Multi-component diffusion characterization of radiation-induced white matter damage. Med Phys 2017; 44:1747-1754. [PMID: 28222217 DOI: 10.1002/mp.12170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE We used multi-b-value diffusion models to characterize microstructural white matter changes after brain radiation into fast and slow components, in order to better understand the pathophysiology of radiation-induced tissue damage. METHODS Fourteen patients were included in this retrospective analysis with imaging prior to, and at 1, 4-5, and 9-10 months after radiotherapy (RT). Diffusion signal decay within brain white matter was fit to a biexponential model to separate changes within the slow and fast components. Linear mixed-effects models were used to obtain estimates of the effect of radiation dose and time on the model parameters. RESULTS We found an increase of 0.11 × 10-4 and 0.14 × 10-4 mm2 /s in the fast diffusion coefficient per unit dose-time (Gy-month) in the longitudinal and transverse directions, respectively. By contrast, the longitudinal slow diffusion coefficient decreased independently of dose, by 0.18 × 10-4 , 0.16 × 10-4 , and 0.098 × 10-4 mm2 /s at 1, 4, and 9 months post-RT, respectively. CONCLUSIONS Radiation-induced white matter changes in the first year following RT are driven by dose-dependent increases in the fast component and dose-independent decreases in the slow component.
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Affiliation(s)
- Roshan A Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Nathan S White
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Michael Connor
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Niclas Pettersson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Tyler M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Joshua Kuperman
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Anders M Dale
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
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Molitoris JK, Edelman MJ, Regine WF, Feigenberg SJ. Whole-Brain Radiation in the Treatment of Brain Metastases in ALK-Positive Non–Small-Cell Lung Cancer. J Clin Oncol 2017; 35:809-810. [DOI: 10.1200/jco.2016.69.7227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jason K. Molitoris
- Jason K. Molitoris, University of Maryland Medical Center, Baltimore, MD; Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; and William F. Regine and Steven J. Feigenberg, University of Maryland School of Medicine, Baltimore, MD
| | - Martin J. Edelman
- Jason K. Molitoris, University of Maryland Medical Center, Baltimore, MD; Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; and William F. Regine and Steven J. Feigenberg, University of Maryland School of Medicine, Baltimore, MD
| | - William F. Regine
- Jason K. Molitoris, University of Maryland Medical Center, Baltimore, MD; Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; and William F. Regine and Steven J. Feigenberg, University of Maryland School of Medicine, Baltimore, MD
| | - Steven J. Feigenberg
- Jason K. Molitoris, University of Maryland Medical Center, Baltimore, MD; Martin J. Edelman, University of Maryland Greenebaum Cancer Center, Baltimore, MD; and William F. Regine and Steven J. Feigenberg, University of Maryland School of Medicine, Baltimore, MD
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