1
|
Welch MR. Management of Complications in Neuro-oncology Patients. Continuum (Minneap Minn) 2023; 29:1844-1871. [PMID: 38085901 DOI: 10.1212/con.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The purpose of this article is to familiarize the reader with the spectrum of neurologic and medical complications relevant to the care of patients with neurologic cancer while highlighting best practices to prevent morbidity and mortality. Topics include tumor-related epilepsy, vasogenic edema, complications of corticosteroid use, disruption of the hypothalamic-pituitary axis, venous thromboembolism, and opportunistic infection. LATEST DEVELOPMENTS In 2021, a joint guideline from the Society for Neuro-Oncology and the European Association of Neuro-Oncology reaffirmed recommendations first established in 2000 that patients with newly diagnosed brain tumors should not be prescribed an antiseizure medication prophylactically. For those with tumor-related epilepsy, monotherapy with a non-enzyme-inducing anticonvulsant is the preferred initial treatment, and levetiracetam remains the preferred first choice. Surveys of physician practice continue to demonstrate excessive use of glucocorticoids in the management of patients with both primary and metastatic central nervous system malignancy. This is particularly concerning among patients who require checkpoint inhibitors as the efficacy of these agents is blunted by concomitant glucocorticoid use, resulting in a reduction in overall survival. Finally, direct oral anticoagulants have been shown to be safe in patients with brain tumors and are now favored as first-line treatment among those who require treatment for venous thromboembolism. ESSENTIAL POINTS Medical care for patients impacted by primary and secondary central nervous system malignancy is complex and requires a committed team-based approach that routinely calls upon the expertise of physicians across multiple fields. Neurologists have an important role to play and should be familiar with the spectrum of complications impacting these patients as well as the latest recommendations for management.
Collapse
|
2
|
Ryder CY, Bellile EL, VanKoevering KK, McKean EL. Assessing Quality of Life among Radiation-Induced Hypopituitary Patients. J Neurol Surg B Skull Base 2023; 84:567-577. [PMID: 37854537 PMCID: PMC10581824 DOI: 10.1055/a-1934-9377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022] Open
Abstract
Introduction Radiation-induced hypopituitarism (RIH) has long been recognized as one of the deleterious side effects of skull base radiation. This study aims to assess the quality of life (QoL) among patients with RIH compared with radiated patients who did not develop hypopituitarism using the validated Anterior Skull Base Questionnaire (ASBQ). Methods This was a single-institution retrospective cohort study. Included patients had a history of anterior skull base tumor, underwent at least one round of radiation to the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Three statistical models were used to determine the effect of hypopituitarism and treatment on QoL scores. Results A total of 145 patients met inclusion criteria, and 330 ASBQ surveys were analyzed. Thirty-five percent (51/145) had evidence of RIH at some point after their radiation treatment. Those with hypopituitarism had significantly lower overall ASBQ scores across all three models even after adjusting for potential confounders and intraperson correlation (average decrease of 0.24-0.45 on a 5-point Likert scale; p -values ranging from 0.0004 to 0.018). The increase in QoL with hormonal replacement was modulated by time out from radiation, with long-term survivors (5+ years out from radiation) gaining the most benefit from treatment (increase of 0.89 on a 5-point Likert scale, p 0.0412), especially in the vitality domain. Conclusion This data demonstrates that hypopituitarism is an independent predictor of lower QoL. Early detection and appropriate treatment are essential to avoid the negative impact of hypopituitarism on QoL.
Collapse
Affiliation(s)
- C Yoonhee Ryder
- University of Michigan Medical School, Office of Medical Student Education, Ann Arbor, Michigan, United States
| | - Emily L. Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States
| | - Kyle K. VanKoevering
- Department of Otolaryngology, Ohio State University, Columbus, Ohio, United States
| | - Erin L. McKean
- Department of Otolaryngology Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
| |
Collapse
|
3
|
Fagundes MA, Peres SV, Assumpção PP, Curado MP. Physical activity and gastric cancer risk: a case-control study in the Amazon region of Brazil. Eur J Cancer Prev 2021; 30:437-441. [PMID: 33369944 DOI: 10.1097/cej.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gastric cancer is the fifth most common cancer worldwide. Investigations of lifestyle factors such as physical activity may identify risk patterns in this population. Thus, the aim of this study was to analyze the level of habitual physical activity and its association with the risk of gastric adenocarcinoma in the Amazon region. We conducted a hospital-based case-control study. Questionnaires investigating sociodemographic characteristics and physical activity were applied between July 2017 and April 2019. To assess habitual physical activity, we used the Baecke Physical Activity Questionnaire, which assessed physical exercise (PE), occupational physical activity, and leisure and locomotion activity (LLA). The Chi-square association test was applied and univariate and multiple binary logistic regression models were used for odds ratio analysis. The descriptive level of 5% (P < 0.05) was selected for statistical significance. The sample consisted of 297 individuals, with 147 cases and 150 controls. Those who performed PE at the second percentile level for 5 years before the interview were 71% less likely to develop gastric cancer (P = 0.012). Individuals with the highest LLA levels during the preceding 10 and 15 years were 76 and 78% less likely to have gastric cancer, respectively. In this study, physical activity related to sport and to leisure and locomotion was an independent protective factor that was inversely associated with gastric cancer.
Collapse
Affiliation(s)
- Marcela A Fagundes
- Department of Epidemiology and Statistics on Cancer Group, International Research Center, A.C. Camargo Cancer Center
| | - Stela V Peres
- Department of Epidemiology and Statistics on Cancer Group, International Research Center, A.C. Camargo Cancer Center
- Department of Cancer Hospital Registration, Fundação Oncocentro de São Paulo, Sao Paulo, SP
| | - Paulo P Assumpção
- Department of Oncology Research Center, Universidade Federal do Pará, Guamá, Belem, PA, Brazil
| | - Maria P Curado
- Department of Epidemiology and Statistics on Cancer Group, International Research Center, A.C. Camargo Cancer Center
| |
Collapse
|
4
|
Sanz-Paris A, Martinez-Trufero J, Lambea-Sorrosal J, Milà-Villarroel R, Calvo-Gracia F. Impact of an Oral Nutritional Protocol with Oligomeric Enteral Nutrition on the Quality of Life of Patients with Oncology Treatment-Related Diarrhea. Nutrients 2020; 13:E84. [PMID: 33383949 PMCID: PMC7824279 DOI: 10.3390/nu13010084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Nutritional status can influence the quality of life (QoL) of cancer patients. (2) Methods: This subanalysis evaluated the impact of an oral oligomeric enteral nutrition (OEN) protocol on the QoL of patients with oncology treatment-related diarrhea (OTRD) in a multicenter, observational, prospective study (DIAPOENO study). QoL was assessed with the Nottingham Health Profile (NHP) at baseline and after eight weeks of OEN treatment. (3) In the overall population, all the NHP categories significantly improved after eight weeks of OEN treatment: energy levels (p < 0.001), pain (p < 0.001), emotional reactions (p < 0.001), sleep (p < 0.001), social isolation (p = 0.023), and physical abilities (p = 0.001). QoL improvement was higher in patients with improved or maintained nutritional status and in those with improved consistency of stools with the OEN protocol. However, QoL did not significantly improve in patients with worse nutritional status and with worse or maintained stool consistency with the OEN protocol. QoL improved regardless of disease severity. Multivariate logistic regression analysis showed that weight change was significantly associated with improved QoL (OR 2.90-5.3), except for social isolation, in models unadjusted and adjusted to age, sex, oncology treatment, and stool consistency. (4) Conclusion: In this subanalysis, the OEN protocol was associated with improved QoL.
Collapse
Affiliation(s)
- Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain
| | | | | | - Raimon Milà-Villarroel
- Group Research on Wellbeing (GRoW), Blanquerna School of Health Sciences-Universitat Ramon Llull, 08025 Barcelona, Spain;
| | - Fernando Calvo-Gracia
- Department of Endocrinology and Nutrition, University Clinic Hospital, 50009 Zaragoza, Spain;
| | | |
Collapse
|
5
|
Janssen S, Mehta P, Bartscht T, Schmid SM, Fahlbusch FB, Rades D. Prevalence of metastases within the hypothalamic-pituitary area in patients with brain metastases. Radiat Oncol 2019; 14:152. [PMID: 31455428 PMCID: PMC6712746 DOI: 10.1186/s13014-019-1337-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
Aim To quantify the prevalence of brain metastases involving the hypothalamic-pituitary (HT-P) area. Introduction Cognitive impairment and fatigue are common side effects of whole brain irradiation (WBI) comprising the quality of life (QoL) for survivors. While the former is related to radiation-induced hippocampal injury, the latter could be secondary to hormonal disbalance as a consequence of radiation of the HT-P area. Thus, sparing both regions from higher irradiation doses could reduce these sequelae. Methods T1 contrast medium enhanced magnetic resonance imaging (MRI) scans of 865 patients with brain metastases (4,280 metastases) were reviewed. HT-P area was individually contoured with a margin of 5 mm in order to evaluate the prevalence of brain metastases in this region. Results Involvement of the hypothalamic region was found in 26 patients (involvement rate of 3% for patients and 1% for metastases), involvement of the pituitary gland in 9 patients (1% for patients and < 1% for metastases). Binary logistical regression analysis revealed the presence of > 10 brain metastases as the only factor associated with hypothalamic involvement while no distinct factor was associated with an involvement of the pituitary gland. Conclusion The low prevalence of metastases within the HT-P area in patients with brain metastases calls for further studies examining whether sparing of this region might improve patients QoL.
Collapse
Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. .,Private Practice of Radiation Oncology, Hannover, Germany. .,Klinik für Strahlentherapie, Universität zu Lübeck, Ratzeburger Allee 160, Haus 40, 23562, Lübeck, Germany.
| | - Preena Mehta
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Haematology and Oncology, University of Lübeck, Lübeck, Germany
| | - Sebastian M Schmid
- Department of Endocrinology, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
6
|
Ajmal A, McKean E, Sullivan S, Barkan A. Decreased quality of life (QoL) in hypopituitary patients: involvement of glucocorticoid replacement and radiation therapy. Pituitary 2018; 21:624-630. [PMID: 30349995 DOI: 10.1007/s11102-018-0918-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Hypopituitary patients are assumed to have decreased QoL due to GHD. However, in placebo controlled trials, the effects of GH replacement are no different from placebo. Hydrocortisone dose > 20 mg/day and pituitary radiation are independently associated with poorer QoL. We assessed QoL in panhypopituitary GH- deficient patients never treated with GH. METHODS Study group was divided into: (a) surgery followed by radiation (n = 21) and (b) surgery alone (n = 32). Mean duration of GHD was 71.4 ± 7.8 months and mean daily hydrocortisone dose was 15 ± 0.7 mg. Control group had transnasal surgery for benign sinus conditions (n = 54). RESULTS AGHDA scores were significantly worse in the entire study group compared to controls (8.1 ± 1.0 vs. 5.1 ± 0.9, p = 0.03). In patients with history of radiation therapy AGHDA scores were significantly worse than in controls (9.1 ± 1.5, p = 0.02) and SNOT-22 (Sino-Nasal Outcome Test) scores were also significantly worse (15.8 ± 2.0 vs. 23.2 ± 3.5, p = 0.04). However, AGHDA scores in patients without history of radiation and on "physiological" dose of hydrocortisone were similar to those in controls (5.1 ± 0.9 vs. 7.3 ± 1.3, p = 0.17). CONCLUSIONS Replacement with hydrocortisone doses not exceeding 20 mg/day and avoidance of radiation therapy was accompanied by normal QoL in patients not replaced with GH. Thus, we suggest that the decreased QoL in hypopituitary patients may not be due to GH deficiency per se, but rather to high hydrocortisone doses and to aftereffects of cranial radiation.
Collapse
Affiliation(s)
- Adnan Ajmal
- Division of Metabolism, Endocrinology and Diabetes, Department of Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, Ann Arbor, MI, 48106, USA
| | - Erin McKean
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Ariel Barkan
- Division of Metabolism, Endocrinology and Diabetes, Department of Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, Ann Arbor, MI, 48106, USA.
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
7
|
Barber SM, Teh BS, Baskin DS. Fractionated Stereotactic Radiotherapy for Pituitary Adenomas: Single-Center Experience in 75 Consecutive Patients. Neurosurgery 2017; 79:406-17. [PMID: 26657072 DOI: 10.1227/neu.0000000000001155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Early results of postoperative fractionated stereotactic radiotherapy (FSRT) for functional and nonfunctional pituitary adenomas appear promising, but the majority of available evidence draws from small series with insufficient follow-up data to draw meaningful conclusions. OBJECTIVE To evaluate the long-term outcomes of a large series of patients undergoing FSRT for both functional and nonfunctional pituitary adenomas with the Novalis system (BrainLAB, Heimstetten, Germany). METHODS Chart data for 75 consecutive patients undergoing FSRT for a pituitary tumor (21 functional and 54 nonfunctional adenomas) at our institution between January 2004 and June 2013 were reviewed. RESULTS Radiographic progression-free survival was 100% over a mean of 47.8 months of radiographic follow-up (range, 12.0-131.2 months). Hormonal normalization was seen in 69.2% of patients with functional adenomas after FSRT, whereas 30.8% experienced partial hormonal control. Mild, grade I acute adverse effects were observed during radiotherapy treatment in 36 patients (48%), and objective, persistent worsening of vision occurred in a single patient (1.5%) after FSRT. New hormonal deficits were seen in 28.0% of patients after FSRT. Radiographic responses were inversely related to tumor volume. CONCLUSION FSRT delivers radiographic and functional outcomes similar to those seen with stereotactic radiosurgery and conventional radiotherapy with less resultant toxicity. FSRT is most beneficial for smaller tumors (those <3 cm in diameter). ABBREVIATIONS EBRT, external beam radiotherapyFSRT, fractionated stereotactic radiotherapyOR, odds ratioPTV, planning target volumeSRS, stereotactic radiosurgery.
Collapse
Affiliation(s)
- Sean M Barber
- *Houston Methodist Neurological Institute, Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; ‡Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas; §Kenneth R. Peak Brain and Pituitary Tumor Treatment Center, Houston Methodist Hospital, Houston, Texas
| | | | | |
Collapse
|
8
|
Ji S, Tian Y, Lu Y, Sun R, Ji J, Zhang L, Duan S. Irradiation-induced hippocampal neurogenesis impairment is associated with epigenetic regulation of bdnf gene transcription. Brain Res 2014; 1577:77-88. [PMID: 25020123 DOI: 10.1016/j.brainres.2014.06.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/07/2014] [Accepted: 06/27/2014] [Indexed: 01/19/2023]
Abstract
Radiotherapy is often employed for the treatment of head and neck cancer. Unfortunately, its neurotoxic effects on normal brain tissue often compromise the quality of life (QOL) for survivors. Particularly, acute cognitive deficit (ACD), which can occur several days to one month after irradiation, limits its therapeutic use. Impairment of neurogenesis in the hippocampus plays a key role in the development of radiation-induced cognitive deficit, and brain-derived neurotrophic factor (BDNF) may be involved. In the present study, we re-evaluated the effects of different doses of radiation on the development of ACD in Sprague Dawley rats. Our results showed that 30 Gy, but not 2 Gy or 10 Gy of whole brain radiation (WBI), led to significant deficits in cognitive functions at one month post-irradiation. At 7 and 30 days post-irradiation, immunofluorescence showed WBI had seriously impeded the production of new neurons and shortened their survival time. Additionally, decreased bdnf mRNA and protein expression were also observed. A significant decrease in histone deacetylase 1 (HDAC1)-dependent H3 acetylation was observed at bdnf promoters by ChIP analysis. TSA, an HDAC inhibitor, triggered bdnf transcription and rescued neurogenesis impairment following WBI. In summary, our results suggest that a single-dose exposure to 30 Gy WBI induced acute cognitive dysfunction in rats. Additionally, radiation-induced persistent inhibition of bdnf gene transcription resulting from lowered rates of HDAC1-dependent H3 acetylation was associated with long-term impairment of neurogenesis in the denate gyrus (DG). Triggering of BDNF-TrkB signaling by inhibition of HDAC-1 may be used to stimulate neurogenesis.
Collapse
Affiliation(s)
- Shengjun Ji
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu 215004, China
| | - Ye Tian
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu 215004, China.
| | - Yi Lu
- The Institute of Neuroscience, Zhejiang University, Yuhangtang Road No. 866, Hangzhou, Zhejiang, China
| | - Rui Sun
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu 215004, China
| | - Jianfeng Ji
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu 215004, China
| | - Liyuan Zhang
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu 215004, China
| | - Shumin Duan
- The Institute of Neuroscience, Zhejiang University, Yuhangtang Road No. 866, Hangzhou, Zhejiang, China
| |
Collapse
|
9
|
Nieder C, Andratschke NH, Grosu AL. Normal tissue studies in radiation oncology: A systematic review of highly cited articles and citation patterns. Oncol Lett 2014; 8:972-976. [PMID: 25120644 PMCID: PMC4114634 DOI: 10.3892/ol.2014.2252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 05/15/2014] [Indexed: 11/25/2022] Open
Abstract
Radiation therapy is one of the cornerstones of modern multidisciplinary cancer treatment. Normal tissue tolerance is critical as radiation-induced side effects may compromise organ function and quality of life. The importance of normal tissue research is reflected by the large number of scientific articles, which have been published between 2006 and 2010. The present study identified important areas of research as well as seminal publications. The article citation rate is among the potential indicators of scientific impact. Highly cited articles, arbitrarily defined as those with ≥15 citations, were identified via a systematic search of the citation database, Scopus. Up to 608 articles per year were published between 2006 and 2010, however, <10% of publications in each year accumulated ≥15 citations. This figure is notably low, when compared with other oncology studies. A large variety of preclinical and clinical topics, including toxicity prediction, the dose-volume relationship and radioprotectors, accumulated ≥15 citations. However, clinical prevention or mitigation studies were underrepresented. The following conclusion may be drawn from the present study; despite the improved technology that has resulted in superior dose distribution, clinical prevention or mitigation studies are critical and must receive higher priority, funding and attention.
Collapse
Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø 8092, Norway ; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø 9038, Norway
| | | | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg D-79106, Germany
| |
Collapse
|
10
|
Olsson E, Eckerström C, Berg G, Borga M, Ekholm S, Johannsson G, Ribbelin S, Starck G, Wysocka A, Löfdahl E, Malmgren H. Hippocampal volumes in patients exposed to low-dose radiation to the basal brain. A case-control study in long-term survivors from cancer in the head and neck region. Radiat Oncol 2012. [PMID: 23193977 PMCID: PMC3570441 DOI: 10.1186/1748-717x-7-202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An earlier study from our group of long time survivors of head and neck cancer who had received a low radiation dose to the hypothalamic-pituitary region, with no signs of recurrence or pituitary dysfunction, had their quality of life (QoL) compromised as compared with matched healthy controls. Hippocampal changes have been shown to accompany several psychiatric conditions and the aim of the present study was to test whether the patients' lowered QoL was coupled to a reduction in hippocampal volume. METHODS Patients (11 men and 4 women, age 31-65) treated for head and neck cancer 4-10 years earlier and with no sign of recurrence or pituitary dysfunction, and 15 matched controls were included. The estimated radiation doses to the basal brain including the hippocampus (1.5 - 9.3 Gy) had been calculated in the earlier study. The hippocampal volumetry was done on coronal sections from a 1.5 T MRI scanner. Measurements were done by two independent raters, blinded to patients and controls, using a custom method for computer assisted manual segmentation. The volumes were normalized for intracranial volume which was also measured manually. The paired t test and Wilcoxon's signed rank test were used for the main statistical analysis. RESULTS There was no significant difference with respect to left, right or total hippocampal volume between patients and controls. All mean differences were close to zero, and the two-tailed 95% confidence interval for the difference in total, normalized volume does not include a larger than 8% deficit in the patients. CONCLUSION The study gives solid evidence against the hypothesis that the patients' lowered quality of life was due to a major reduction of hippocampal volume.
Collapse
Affiliation(s)
- Erik Olsson
- Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|