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Schroyen G, Sleurs C, Ottenbourgs T, Leenaerts N, Nevelsteen I, Melis M, Smeets A, Deprez S, Sunaert S. Changes in leukoencephalopathy and serum neurofilament after (neo)adjuvant chemotherapy for breast cancer. Transl Oncol 2023; 37:101769. [PMID: 37651891 PMCID: PMC10480307 DOI: 10.1016/j.tranon.2023.101769] [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: 03/31/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Previous case studies have provided evidence for chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective research is lacking. Hence, we investigated leukoencephalopathy before and after chemotherapy and its association with a serum neuroaxonal damage marker. METHODS This prospective cohort study included 40 patients receiving chemotherapy for breast cancer, and two age- and education-matched control groups, recruited between 2018 and 2021 (31-64 years of age). The latter control groups consisted of 39 chemotherapy-naïve patients and 40 healthy women. Fluid-attenuated inversion-recovery magnetic resonance imaging was used for lesion volumetry (total, juxtacortical, periventricular, infratentorial, and deep white matter) and blood serum to measure neurofilament light chain (NfL) levels. Acquisition took place pre-chemotherapy and three months and one-year post-chemotherapy, or at corresponding intervals. Within/between group differences were compared using robust mixed-effects modeling, and associations between total lesion volume and serum-NfL with linear regression. RESULTS Stronger increases in deep white matter lesion volumes were observed shortly post-chemotherapy, compared with healthy women (ßstandardized=0.09, pFDR<0.001). Increases in total lesion volume could mainly be attributed to enlargement of existing lesions (mean±SD, 0.12±0.16 mL), rather than development of new lesions (0.02±0.02 mL). A stronger increase in serum-NfL concentration was observed shortly post-chemotherapy compared with both control groups (ß>0.70, p<0.004), neither of which showed any changes over time, whereas a decrease was observed compared with healthy women one-year post-chemotherapy (ß=-0.54, p = 0.002). Serum-NfL concentrations were associated with lesion volume one-year post-chemotherapy (or at matched timepoint; ß=0.36, p = 0.010), whereas baseline or short-term post-therapy levels or changes were not. CONCLUSION These results underscore the possibility of chemotherapy-induced leukoencephalopathy months post-treatment, as well as the added value of serum-NfL as a prognostic marker for peripheral/central neurotoxicity. TRANSLATIONAL RELEVANCE Previous case studies have provided evidence of chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective studies to estimate longitudinal changes are currently missing. In this study, we used longitudinal fluid-attenuated inversion-recovery magnetic resonance imaging to assess white matter lesion volumes in patients treated for non-metastatic breast cancer and healthy women. Our findings demonstrate that chemotherapy-treated patients exhibit stronger increases in lesion volumes compared with healthy women, specifically in deep white matter, at three months post-chemotherapy. Increases could mainly be attributed to enlargement of existing lesions, rather than development of new lesions. Last, serum concentrations of neurofilament light chain, a neuroaxonal damage marker, increased shortly after chemotherapy and long-term post-chemotherapy levels were associated with lesion volumes. These findings highlight the potential of this non-invasive serum marker as a prognostic marker for peripheral and/or central neurotoxicity. Implementation in clinical practice could aid in therapeutic decisions, assessing disease activity, or monitoring treatment response.
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Affiliation(s)
- Gwen Schroyen
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Charlotte Sleurs
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Tilburg University, Department of Cognitive Neuropsychology, Tilburg, the Netherlands; KU Leuven, Department of Oncology, Leuven, Belgium
| | - Tine Ottenbourgs
- KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Nicolas Leenaerts
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Neurosciences, Mind-Body Research, Leuven, Belgium; KU Leuven, University Psychiatric Center, Leuven, Belgium; University Hospitals Leuven, Department of Psychiatry, Leuven, Belgium
| | - Ines Nevelsteen
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Michelle Melis
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Ann Smeets
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Sabine Deprez
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium.
| | - Stefan Sunaert
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
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Yang Y, Gorka SM, Pennell ML, Weinhold K, Orchard T. Intolerance of Uncertainty and Cognition in Breast Cancer Survivors: The Mediating Role of Anxiety. Cancers (Basel) 2023; 15:3105. [PMID: 37370715 PMCID: PMC10296605 DOI: 10.3390/cancers15123105] [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: 05/15/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI) is one of the most prevalent symptoms that breast cancer survivors experience. While cancer treatments are established contributors to CRCI, inter-individual differences in CRCI are not well understood. Individual differences in sensitivity to uncertainty are potential contributors to CRCI; however, no prior studies have attempted to examine this link in the context of breast cancer. To address the gap, we used preliminary findings from an ongoing cross-sectional study. A total of 38 women with stage I-III breast cancer (1-4 years post-treatment) were included in this study. Intolerance of uncertainty (IU) was assessed using the Intolerance of Uncertainty Scale. Self-reported cognitive function was assessed with the Neuro-QoL questionnaire. Anxiety was assessed using the Patient-Reported Outcomes Measurement System Bank. From this study, we found that anxiety mediates the association between IU and cognitive function of survivors. In other words, among post-menopausal breast cancer survivors, those with higher IU showed higher anxiety and consequently had lower cognitive function. This finding suggests that assessing IU may help predict the risk of CRCI. This study expands the current knowledge that addresses the importance of IU as a factor associated with cognitive health.
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Affiliation(s)
- Yesol Yang
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center-James, 406 W 10th Avenue, Columbus, OH 43210, USA;
| | - Stephanie M. Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W 9th Avenue, Columbus, OH 43210, USA;
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210, USA
| | - Michael L. Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA;
| | - Kellie Weinhold
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA;
| | - Tonya Orchard
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA;
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Pope B, Wolcott Z, Castillo M, Jin J, Wong KH, Havenon AD, Yaghi S, Goldstein ED. Mutation of breast cancer susceptibility genes increases cerebral microbleeds: A pilot study. J Stroke Cerebrovasc Dis 2022; 31:106729. [PMID: 36116220 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106729] [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: 01/18/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Growing evidence suggests breast cancer susceptibility gene (BRCA) mutations may augment cerebrovascular risk factors. With this influence in mind, we aimed to identify if BRCA mutations increased the prevalence of cerebral small vessel disease (CSVD). METHODS AND MATERIALS We performed a retrospective cross-sectional analysis of adults undergoing malignancy evaluation with confirmed BRCA mutations compared to BRCA wildtype individuals. A standard-of-care brain MRI was reviewed. Chi-squared or Fisher's, Wilcoxon rank-sum and the Student's t-test analyses were used when appropriate. Adjusted logistic regression models were fit to calculate odds ratio. Multicollinearity was tested by variance inflation factor calculation and for goodness-of-fit via the Hosmer-Lemeshow test. RESULTS Of 116 individuals, 44.8% (52/116) carried a BRCA mutation. Demographic and cerebrovascular risk factors did not differ. Cerebral microbleeds were more common in those with BRCA mutation: [32.7% (17/52) vs. 17.2% (11/64), p = 0.05] with an adjusted odds ratio of 2.8 (95%CI 1.08-6.89, p = 0.03). Other markers of CSVD were similar amongst the cohort. CONCLUSIONS We identified a nearly 3-fold increase in identified cerebral microbleed in those with BRCA mutations compared with BRCA wildtype individuals suggestive of an interaction between the BRCA gene and cerebral microbleed formation. Further studies are needed to confirm our findings and to understand clinical implications.
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Affiliation(s)
- Brandon Pope
- Division of Vascular Neurology, Department of Neurology University of Utah, Salt Lake City, UT, USA.
| | - Zoe Wolcott
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Marissa Castillo
- Division of Vascular Neurology, Department of Neurology University of Utah, Salt Lake City, UT, USA.
| | - Jacqueline Jin
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
| | - Ka-Ho Wong
- Division of Vascular Neurology, Department of Neurology University of Utah, Salt Lake City, UT, USA.
| | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
| | - Shadi Yaghi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, 593 Eddy St, APC Bldg, 5th floor, Providence 02903, RI, USA.
| | - Eric D Goldstein
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, 593 Eddy St, APC Bldg, 5th floor, Providence 02903, RI, USA.
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Pan T, Li X, Zhao B, Zhang C, Rong X, Qin C, Wen G, Wu W, Wang H, Lu K, Zhou H, Peng Y. Radiotherapy-Related Neurologic Complications in Patients with Nasopharyngeal Carcinoma: A Multicenter Epidemiologic Study in Southern China. Cancer Epidemiol Biomarkers Prev 2022; 31:1119-1129. [PMID: 35391491 DOI: 10.1158/1055-9965.epi-21-0953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/16/2021] [Accepted: 02/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aim at describing the incidence, potential predisposing factors, and progression of major radiotherapy-related neurologic complications (RRNC) in nasopharyngeal carcinoma (NPC)-endemic regions, especially southern China. METHODS We performed a multicenter longitudinal retrospective study with clinical follow-ups in 22,302 patients with post-radiotherapy NPC between January 2003 and June 2017 covering three major residential areas. Epidemiology, potential predisposing/protective factors, clinicopathologic progression, and survival conditions of each RRNC were separately recorded and analyzed on the basis of their related clinical, radiologic, and laboratory parameters. RESULTS 949 new cases of RRNCs occurred among the 22,302 patients with post-radiotherapy NPC during 101,714 person years' follow-up, which is equal to an incidence density rate of 9.3 new cases per 1000 person year. Radiation-induced cranial nerve palsy showed the highest incidence (2.68%, 597/22,302) with the earliest onset (median latency, 4.45 years) as well. Patients benefited from intensity-modulated radiotherapy (IMRT) over conventional radiotherapy (CRT) in both overall survival (median survival 13.2 years for IMRT vs. 8.3 years for CRT) and RRNC-free survival (except for epilepsy and cranial nerve palsy). Causes of death varied substantially between patients with or without RRNCs. CONCLUSIONS Our study indicates a non-negligible incidence of RRNC spectrum in southern China in the past ten years. IMRT is one of the most significant protectors against development and progression of RRNCs. IMPACT Our findings support the hypothesis that patients with NPC with preexisting predispositions would receive long-term benefits from IMRT and other dose-related modulations (like hyperfractionation and dose conformation).
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Affiliation(s)
- Tong Pan
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiangping Li
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Zhao
- Department of Neurology, Affiliated Hospital, Guangdong Medical College, Zhanjiang, China
| | - Chengguo Zhang
- Department of Neurology, First People's Hospital of Foshan City, Foshan, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chao Qin
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Guoqiang Wen
- Department of Neurology, Hainan General Hospital, Hainan, China
| | - Wenjun Wu
- Department of Neurology, the People's Hospital of Zhongshan City, Shanghai, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kui Lu
- Department of Neurology, the People's Hospital of Zhongshan City, Shanghai, China
| | - Haihong Zhou
- Department of Neurology, Affiliated Hospital, Guangdong Medical College, Zhanjiang, China
| | - Ying Peng
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Schroyen G, Sleurs C, Bartsoen E, Smeets D, van Weehaeghe D, Van Laere K, Smeets A, Deprez S, Sunaert S. Neuroinflammation as potential precursor of leukoencephalopathy in early-stage breast cancer patients: A cross-sectional PET-MRI study. Breast 2022; 62:61-68. [PMID: 35131644 PMCID: PMC8829129 DOI: 10.1016/j.breast.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although chemotherapy-induced leukoencephalopathy has been described in case and cohort studies, literature remains inconclusive about its prevalence and mechanisms. Therefore, we investigated the presence of leukoencephalopathy after multiagent chemotherapy in women treated for breast cancer and potential underlying neuroinflammatory processes. Methods In this exploratory study, 15 chemotherapy-treated and 15 age-matched chemotherapy-naïve patients with early-stage breast cancer, as well as 15 healthy controls underwent simultaneous PET-MR neuroimaging, including T1-weighted MPRAGE, T2-weighted FLAIR and dynamic PET with the 18-kDA translocator protein (TSPO) radioligand [18F]DPA-714. Total and regional (juxtacortical, periventricular, deep white matter and infratentorial) lesion burden were compared between the groups with one-way ANOVA. With paired t-tests, [18F]DPA-714 volume of distribution [VT, including partial volume correction (PVC)] in lesioned and normal appearing white matter (NAWM) were compared within subjects, to investigate inflammation. Finally, two general linear models were used to examine the predictive values of neurofilament light-chain (NfL) serum levels on (1) total lesion burden or (2) PVC [18F]DPA-714 VT of lesions showing elevated inflammation. Results No significant differences were found in total or localized lesion burden. However, significantly higher (20–45%) TSPO uptake was observed in juxtacortical lesions (p ≤ 0.008, t ≥ 3.90) compared to NAWM in both cancer groups, but only persisted for chemotherapy-treated patients after PVC (p = 0.005, t = 4.30). NfL serum levels were not associated with total lesion volume or tracer uptake in juxtacortical lesions. Conclusion This multimodal neuroimaging study suggests that neuroinflammatory processes could be involved in the development of juxtacortical, but not periventricular or deep white matter, leukoencephalopathy shortly after chemotherapy for early-stage breast cancer. No increased white matter lesion load in breast cancer patients. No differences in TSPO uptake in periventricular or deep white matter lesions. Higher TSPO uptake in juxtacortical lesions in chemotherapy-treated breast cancer patients. TSPO uptake in inflammatory lesions and NfL levels not significantly associated, despite a trend.
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Balzano RF, Mannatrizio D, Castorani G, Perri M, Pennelli AM, Izzo R, Popolizio T, Guglielmi G. Imaging of Cerebral Microbleeds: Primary Patterns and Differential Diagnosis. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phillips NS, Rao V, Kmetz L, Vela R, Medick S, Krull K, Kesler SR. Changes in Brain Functional and Effective Connectivity After Treatment for Breast Cancer and Implications for Intervention Targets. Brain Connect 2021; 12:385-397. [PMID: 34210168 PMCID: PMC9131353 DOI: 10.1089/brain.2021.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with breast cancer frequently report cognitive impairment both during and after completion of therapy. Evidence suggests that cancer-related cognitive impairments are related to widespread neural network dysfunction. The default mode network (DMN) is a large conserved network that plays a critical role in integrating the functions of various neural systems. Disruption of the network may play a key role in the development of cognitive impairment. Methods: We compared neuroimaging and neurocognitive data from 43 newly diagnosed primary breast cancer patients (mean age = 48, standard deviation [SD] = 8.9 years) and 50 frequency-matched healthy female controls (mean age = 50, SD = 10 years) before treatment and 1 year after treatment completion. Functional and effective connectivity measures of the DMN were obtained using graph theory and Bayesian network analysis methods, respectively. Results: Compared with healthy females, the breast cancer group displayed higher global efficiency and path length post-treatment (p < 0.03, corrected). Breast cancer survivors showed significantly lower performance on measures of verbal memory, attention, and verbal fluency (p < 0.05) at both time points. Within the DMN, local brain network organization, as measured by edge-betweenness centralities, was significantly altered in the breast cancer group compared with controls at both time points (p < 0.0001, corrected), with several connections showing a significant group-by-time effect (p < 0.003, corrected). Effective connectivity demonstrated significantly altered patterns of neuronal coupling in patients with breast cancer (p < 0.05). Significant correlations were seen between hormone blockade therapy, radiation therapy, chemotherapy cycles, memory, and verbal fluency test and edge-betweenness centralities. Discussion: This pattern of altered network organization in the default mode is believed to result in reduced network efficiency and disrupted communication. Subregions of the DMN, the orbital prefrontal cortex and posterior memory network, appear to be at the center of this disruption and this could inform future interventions.
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Affiliation(s)
- Nicholas S Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Lorie Kmetz
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Ruben Vela
- School of Nursing, University of Texas at Austin, Austin, Texas, USA.,Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Medick
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, Texas, USA.,Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA.,Center for Computational Oncology, Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas, USA
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Brain structure prior to non-central nervous system cancer diagnosis: A population-based cohort study. NEUROIMAGE-CLINICAL 2021; 28:102466. [PMID: 33395962 PMCID: PMC7578754 DOI: 10.1016/j.nicl.2020.102466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022]
Abstract
In a population-based setting we studied brain structure before cancer diagnosis. Brain structure was not altered before non-CNS cancer diagnosis. The effect of cancer on the brain before clinical manifestation is not supported.
Purpose Many studies have shown that patients with non-central nervous system (CNS) cancer can have brain abnormalities, such as reduced gray matter volume and cerebral microbleeds. These abnormalities can sometimes be present even before start of treatment, suggesting a potential detrimental effect of non-CNS cancer itself on the brain. In these previous studies, psychological factors associated with a cancer diagnosis and selection bias may have influenced results. To overcome these limitations, we investigated brain structure with magnetic resonance imaging (MRI) prior to cancer diagnosis. Patients and methods Between 2005 and 2014, 4,622 participants from the prospective population-based Rotterdam Study who were free of cancer, dementia, and stroke, underwent brain MRI and were subsequently followed for incident cancer until January 1st, 2015. We investigated the association between brain MRI measurements, including cerebral small vessel disease, volumes of global brain tissue, lobes, and subcortical structures, and global white matter microstructure, and the risk of non-CNS cancer using Cox proportional hazards models. Age was used as time scale. Models were corrected for e.g. sex, intracranial volume, educational level, body mass index, hypertension, diabetes mellitus, smoking status, alcohol use, and depression sum-score. Results During a median (interquartile range) follow-up of 7.0 years (4.9–8.1), 353 participants were diagnosed with non-CNS cancer. Results indicated that persons who develop cancer do not have more brain abnormalities before clinical manifestation of the disease than persons who remain free of cancer. The largest effect estimates were found for the relation between presence of lacunar infarcts and the risk of cancer (hazard ratio [HR] 95% confidence interval [CI] = 1.39 [0.97–1.98]) and for total brain volume (HR [95%CI] per standard deviation increase in total brain volume = 0.76 [0.55–1.04]). Conclusion We did not observe associations between small vessel disease, brain tissue volumes, and global white matter microstructure, and subsequent cancer risk in an unselected population. These findings deviate from previous studies indicating brain abnormalities among patients shortly after cancer diagnosis.
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Tong T, Lu H, Zong J, Lv Q, Chu X. Chemotherapy-related cognitive impairment in patients with breast cancer based on MRS and DTI analysis. Breast Cancer 2020; 27:893-902. [PMID: 32301096 DOI: 10.1007/s12282-020-01094-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this study is to investigate chemotherapy-related cognitive impairment (CRCI) in breast cancer patients, analyze absolute concentration and structural changes of metabolites in different brain regions by multimodal neuroimaging technology, and explore correlation between them. Breast cancer patients with chemotherapy treatment group (Ctx+, N = 24) and control group without treatment (Ctx-, N = 20) underwent neuropsychological tests, multivoxel magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before and after chemotherapy. Regions of interest (ROls) in magnetic resonance scan include bilateral posterior cingulate gyrus (PCG), bilateral dorsal thalamus (DT), bilateral lenticular nucleus (LN), bilateral posterior horn of the lateral ventricle paratrigonal white matter (PWM). In MRS, absolute concentrations of N-acetylaspartate (NAA), myo-inositol (MI), choline-containing compounds (Cho), total creatine (tCr), glutamine + glutamate (Glx) were quantified using LC Model and SAGE software. In DTI, we used fractional anisotropy (FA) and mean diffusivity (MD) to reflect white matter integrity. In Ctx+ patients, scores of functional assessment of cancer treatment cognition test (FACT-Cog), perceived cognitive impairments (PCI), impact of perceived impairments on quality of life (QOL), perceived cognitive abilities (PCA), auditory-verbal learning test (AVLT) recognition and clock drawing test (CDT) were lower than those before chemotherapy (p < 0.05). In MRS, Ctx+ patients had significantly lower NAA values in bilateral PCG, DT, respectively. The concentrations of tCr were observed to decline in bilateral PCG and right DT. Glx values decreased in right DT. Cho values decreased significantly in bilateral DT. In DTI, Ctx+ patients had lower FA values in bilateral PCG compared with patients before chemotherapy. Among imaging metrics and cognitive scores, positive correlations were observed between changes in AVLT recognition scores and changes in NAA values in bilateral PCG (left PCG: r = 0.470, p < 0.01; right PCG: r = 0.500, p < 0.01). Positive correlations were also found between changes in AVLT recognition and changes in FA values in bilateral PCG (left PCG: r = 0.513, p < 0.01; right PCG: r = 0.563, p < 0.01). Chemotherapy can lead to a decrease in memory function, accompanied by changes in brain metabolite concentration and white matter integrity in some parts of brain.
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Affiliation(s)
- Taishan Tong
- Department of Psychology and Psychiatry, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China
| | - Heng Lu
- Department of Psychology and Psychiatry, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China
| | - Jian Zong
- Department of Magnetic Resonance Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Qing Lv
- Department of Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xing Chu
- Department of Psychology and Psychiatry, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China.
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Schroyen G, Meylaers M, Deprez S, Blommaert J, Smeets A, Jacobs S, Sunaert S, Sleurs C, Uyttebroeck A. Prevalence of leukoencephalopathy and its potential cognitive sequelae in cancer patients. J Chemother 2020; 32:327-343. [PMID: 32799637 DOI: 10.1080/1120009x.2020.1805239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Due to the rising use of chemotherapy treatment in cancer patients and growing survival rates, therapy-induced neurotoxic side effects are increasingly reported. Given the ambiguity about the prevalence and severity of leukoencephalopathy, one of such toxic side effects, in non-central nervous system (CNS) cancer patients, we performed a systematic literature search using the PubMed/Medline database to summarize existing literature regarding leukoencephalopathy epidemiology in non-CNS cancer patients and its potential cognitive sequelae. The search was based on the following terms: ('MRI' OR 'T2-weighted MRI' OR 'FLAIR') AND ('cancer' OR 'tumour' OR 'leukaemia' OR 'neoplasms') AND ('chemotherapy' OR 'radiotherapy') AND ('posterior reversible encephalopathy' OR 'leukoencephalopathy' OR 'cerebral ischaemia' OR 'stroke'). Thirty-two studies discussing the occurrence of leukoencephalopathy in cancer patients were included, of which the majority investigated Acute Lymphoblastic Leukaemia (ALL) patients (n = 22).Regularly scanned ALL patients showed a prevalence of leukoencephalopathy between 17 - 87%, and 15 - 83% of patients presented with leukoencephalopathy when only scanned after a CNS event. When diagnosed with posterior reversible encephalopathy syndrome, 100% of patients showed leukoencephalopathy because its diagnosis is based in part on observable lesions. An increased prevalence was observed in ALL patients treated with higher doses of methotrexate (5 g/m2 MTX, 42 - 87%) when compared to lower doses (< 5 g/m2, 32 - 67%). By contrast, in breast cancer patients, white matter lesions were mainly detected in case of neurological symptoms, but not (yet) clearly associated with chemotherapy administration. However, chemotherapy treatment was associated with more infratentorial microbleeds in breast cancer patients . Up to 50% of other (neurologically asymptomatic) solid tumour patients presented white matter lesions, even years after treatment. When cognitive data were investigated, lesioned patients showed lower scores on neurocognitive tests in 50% of studies, years after ending therapy.In conclusion, leukoencephalopathy is well-documented for ALL patients (with a focus on methotrexate), but there is a lack of knowledge for other intravenous chemotherapeutics, other oncological populations, wider age ranges and possible risk factors (e.g. history of CNS event). Furthermore, the long-term neuropsychological impact and potential risk for neurodegenerative processes due to leukoencephalopathy remains inconclusive. Hence, large international databanks, epidemiological and prospective case-control studies are necessary to stratify risk groups for CNS-related side effects.
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Affiliation(s)
- Gwen Schroyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Ann Smeets
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Jacobs
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Sleurs
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium
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11
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Pathogenesis, Assessments, and Management of Chemotherapy-Related Cognitive Impairment (CRCI): An Updated Literature Review. JOURNAL OF ONCOLOGY 2020; 2020:3942439. [PMID: 32684930 PMCID: PMC7333028 DOI: 10.1155/2020/3942439] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
There are various cancer treatments at present, and chemotherapy is one of the main methods. Chemotherapy-related cognitive impairment (CRCI), as one of the side effects of chemotherapy, has gradually attracted the attention of more and more researchers. CRCI has been verified by subjective reports and objective neuropsychological tests so far. But oncologists' understanding of it and its treatments are still incomplete. In this review, we mainly give a comprehensive overview of the mechanism of CRCI, then describe a variety of evaluation methods, and finally summarize the treatment approaches under current medical conditions and compare it with an excellent article published in 2015 with the aim of providing directions for future research and better understanding of CRCI for clinicians.
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12
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Floyd R, Dyer AH, Kennelly SP. Non-pharmacological interventions for cognitive impairment in women with breast cancer post-chemotherapy: A systematic review. J Geriatr Oncol 2020; 12:173-181. [PMID: 32536427 DOI: 10.1016/j.jgo.2020.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/29/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Cognitive impairment is a well-reported side-effect of chemotherapy in persons with breast cancer. Whilst non-pharmacological interventions have proven efficacious in the management of cognitive impairment in high-risk groups, their efficacy in cognitive impairment post-chemotherapy in patients with breast cancer remains unclear. METHODS Medline, CINAHL, PsycINFO, Web of Science and Cochrane were searched for randomized controlled trials of non-pharmacological interventions for cognitive impairment post-chemotherapy in women with breast cancer. RESULTS Of 429 results, 83 full-texts were reviewed with ten meeting inclusion criteria. Interventions included cognitive training, exercise and complementary therapies. The non-pharmacological interventions assessed displayed variable benefits in subjective and/or objective cognitive assessments, with no strong evidence for beneficial effects across included studies. No studies assessed the efficacy of multi-domain interventions. CONCLUSIONS There is mixed evidence supporting non-pharmacological interventions for cognitive impairment post-chemotherapy in women with breast cancer. Moving forward, multidomain trials combining non-pharmacological interventions are imperative in this high risk cohort.
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Affiliation(s)
- Ruairí Floyd
- Graduate Entry Medical School, University of Limerick, Ireland.
| | - Adam H Dyer
- Department of Age-related Healthcare, Tallaght University Hospital, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Seán P Kennelly
- Department of Age-related Healthcare, Tallaght University Hospital, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
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13
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Chemotherapy-induced brain changes in breast cancer survivors: evaluation with multimodality magnetic resonance imaging. Brain Imaging Behav 2020; 13:1799-1814. [PMID: 30937827 DOI: 10.1007/s11682-019-00074-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chemotherapy related cognitive impairments are common in breast cancer patients undergoing chemotherapy. These cognitive dysfunctions are mainly attributable to chemotherapy related brain structural and functional alterations. Multimodality magnetic resonance imaging (MRI) can reveal brain gray matter volume loss, white matter microstructural disruption, reduced gray matter density, impaired cerebral blood flow and brain structural and functional connection networks at both local and global levels. This review outlines the potential applications of multimodality MR imaging techniques in chemotherapy induced cognitive deficit in breast cancer survivors and provides future research perspective in this field.
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14
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Amidi A, Wu LM. Structural brain alterations following adult non-CNS cancers: a systematic review of the neuroimaging literature. Acta Oncol 2019; 58:522-536. [PMID: 30732518 DOI: 10.1080/0284186x.2018.1563716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Cancer and cancer treatments may impact the brain through several pathways leading to cognitive impairment. Neuroimaging evidence has begun to elucidate the neurobiological underpinnings of cancer-related cognitive impairment. The aim of this paper was to systematically review available literature on structural brain alterations following adult non-central nervous system (CNS) cancers and associated treatments. Methods: This review followed PRISMA guidelines and was registered in PROSPERO (ID#107387). Comprehensive searches were conducted in June 2018 using PubMed and Web of Science. Inclusion criteria were English peer-reviewed journal articles of formal, controlled studies that examined structural neuroimaging outcomes in adult non-CNS cancer patients and survivors. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Thirty-six publications of prospective and cross-sectional studies met inclusion criteria and were included. Structural brain alterations following cancer and its treatment were reported in a majority of the publications as evidenced by reduced global and local gray matter volumes, impaired white matter microstructural integrity, and brain network alterations. Structural alterations were most often evident when cancer-treated groups were compared with healthy controls, and more subtle when compared with cancer controls. Regarding the existence of pretreatment impairments, the evidence was equivocal. There was significant between-study heterogeneity in imaging analytical approaches and use of statistical adjustments. Over half reported associations with cognitive outcomes, though regions and associated cognitive domains were heterogeneous. Conclusions: Structural brain alterations following cancer and cancer treatments were reported in a majority of the reviewed studies. However, the extent of observed alterations depended on the choice of comparison groups. Methodological issues exist that will need to be addressed systematically to ensure the validity of findings. Large-scale prospective studies with extended assessment points are warranted to replicate and build upon initial findings.
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Affiliation(s)
- Ali Amidi
- Department of Psychology & Behavioural Sciences, Unit for Psycho-Oncology & Health Psychology, Aarhus University, Aarhus, Denmark
| | - Lisa M. Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Tabata N, Sueta D, Yamamoto E, Takashio S, Arima Y, Araki S, Yamanaga K, Ishii M, Sakamoto K, Kanazawa H, Fujisue K, Hanatani S, Soejima H, Hokimoto S, Izumiya Y, Kojima S, Yamabe H, Kaikita K, Matsui K, Tsujita K. A retrospective study of arterial stiffness and subsequent clinical outcomes in cancer patients undergoing percutaneous coronary intervention. J Hypertens 2019; 37:754-764. [PMID: 30817457 DOI: 10.1097/hjh.0000000000001949] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Increasing attention is being paid to the relationship between cancer and cardiovascular diseases. In this study, we examined arterial stenosis and stiffness in patients with malignant diseases requiring percutaneous coronary intervention. METHODS This was a retrospective, single-center, observational study. Participants (n = 1003) were divided into a malignant group, with current or past malignant disease, and a nonmalignant group. The ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were evaluated. The endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, stroke, and revascularization within 1 year. RESULTS We observed significantly impaired ABI and baPWV in the malignant group. A total of 148 patients had a cardiovascular event. Kaplan-Meier analysis showed a significantly higher probability of cardiovascular events in the malignant group (P = 0.012). The combination of malignancy with ABI/baPWV identified subgroups with significantly different probabilities of cardiovascular events. Multivariate Cox hazard analysis identified malignancy as an independent predictor of cardiovascular events (hazard ratio, 1.54; 95% confidence interval, 1.06-2.26; P = 0.025) with an increased hazard ratio by adding the status of low ABI/high baPWV to malignancy (hazard ratio, 2.36; 95% confidence interval, 1.35-4.12; P = 0.003). We found significantly higher follow-up baPWV values in the malignancy group (P = 0.016). CONCLUSION Atherosclerosis is advanced and accelerated in patients with malignancy, and these patients had significantly higher rates of adverse cardiovascular events, and their risk might be stratified by ABI and baPWV. REGISTRATION University Hospital Medical Information Network-CTR (http://www.umin.ac.jp/ctr/). IDENTIFIER Kumamoto University Malignancy and Atherosclerosis study (UMIN000028652). PUBLIC ACCESS INFORMATION Opt-out materials are available at the following website: http://www.kumadai-junnai.com/home/wp-content/uploads/akusei.pdf.
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Affiliation(s)
- Noriaki Tabata
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Daisuke Sueta
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Seiji Takashio
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Yuichiro Arima
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Satoshi Araki
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Masanobu Ishii
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Sunao Kojima
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Hiroshige Yamabe
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Koichi Kaikita
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
| | - Kunihiko Matsui
- Department of Community, Family, and General Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine
- Center for Metabolic Regulation of Healthy Aging
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16
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Vitor T, Kozasa EH, Bressan RA, Lacerda SS, Campos Neto GC, Batista IR, Gebrim LH, Cohen L, Amaro E, Felicio AC. Impaired brain dopamine transporter in chemobrain patients submitted to brain SPECT imaging using the technetium-99m labeled tracer TRODAT-1. Ann Nucl Med 2019; 33:269-279. [DOI: 10.1007/s12149-019-01331-2] [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] [Accepted: 01/06/2019] [Indexed: 12/15/2022]
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17
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Pruitt AA. Epidemiology, Treatment, and Complications of Central Nervous System Metastases. Continuum (Minneap Minn) 2018; 23:1580-1600. [PMID: 29200112 DOI: 10.1212/con.0000000000000551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Neurologic problems resulting from systemic cancer metastases to brain parenchyma, dura, spinal cord, and leptomeninges are among the most common types of consultations addressed by neurologists. With patients surviving longer from systemic cancer, along with the rapidly evolving therapeutic options, the treatment of these devastating complications has become both more effective and more complicated. This article reviews current patterns of metastatic disease and the increasingly nuanced landscape of evolving therapies, their complications, and their impact on quality of survival. RECENT FINDINGS Targeted therapies with tyrosine kinase inhibitors and immune checkpoint inhibitors and cytotoxic therapies directed at disease-specific chemosensitivity patterns have dramatically improved the prognosis of non-small cell lung cancer, melanoma, and breast cancer, but have led to some novel complications and altered recurrence patterns. Clinical trials suggest the superiority of hippocampal-avoidance radiation fields and the use of stereotactic radiosurgery over whole-brain radiation therapy to minimize long-term cognitive consequences of radiation therapy. Emerging data document tolerable safety when brain radiation is combined with immunotherapy. Chemotherapy can be a first-line treatment for some inoperable brain metastases, eliminating or deferring whole-brain radiation therapy. Stereotactic body radiation therapy is a new technique of radiation used for spinal and epidural metastases that spares spinal cord tissue while ablating tumors. SUMMARY Metastases to the nervous system remain devastating, but their prognosis and therapies are more heterogeneous than previously appreciated. Neurologists now can offer more personalized prognostic information based on new stratification criteria, can predict drug complications relevant to the nervous system, and can provide critical partnership in the multidisciplinary effort to balance effective longer-term disease control with treatment-related adverse consequences.
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18
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Chow EJ, Chen Y, Hudson MM, Feijen EAM, Kremer LC, Border WL, Green DM, Meacham LR, Mulrooney DA, Ness KK, Oeffinger KC, Ronckers CM, Sklar CA, Stovall M, van der Pal HJ, van Dijk IWEM, van Leeuwen FE, Weathers RE, Robison LL, Armstrong GT, Yasui Y. Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer. J Clin Oncol 2017; 36:44-52. [PMID: 29095680 DOI: 10.1200/jco.2017.74.8673] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose We aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer. Patients and Methods Participants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and stroke. Siblings (n = 4,023) established the baseline population risk. Piecewise exponential models with backward selection estimated the relationships between potential predictors and each outcome. The St Jude Lifetime Cohort Study (n = 1,842) and the Emma Children's Hospital cohort (n = 1,362) were used to validate the CCSS models. Results Ischemic heart disease and stroke occurred in 265 and 295 CCSS participants, respectively. Risk scores based on a standard prediction model that included sex, chemotherapy, and radiotherapy (cranial, neck, and chest) exposures achieved an area under the curve and concordance statistic of 0.70 and 0.70 for ischemic heart disease and 0.63 and 0.66 for stroke, respectively. Validation cohort area under the curve and concordance statistics ranged from 0.66 to 0.67 for ischemic heart disease and 0.68 to 0.72 for stroke. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups. The cumulative incidences at age 50 years among CCSS low-risk groups were < 5%, compared with approximately 20% for high-risk groups ( P < .001); cumulative incidence was only 1% for siblings ( P < .001 v low-risk survivors). Conclusion Information available to clinicians soon after completion of childhood cancer therapy can predict individual risk for subsequent ischemic heart disease and stroke with reasonable accuracy and discrimination through age 50 years. These models provide a framework on which to base future screening strategies and interventions.
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Affiliation(s)
- Eric J Chow
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yan Chen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa M Hudson
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth A M Feijen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leontien C Kremer
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William L Border
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel M Green
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lillian R Meacham
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel A Mulrooney
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kirsten K Ness
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin C Oeffinger
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cécile M Ronckers
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles A Sklar
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marilyn Stovall
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Helena J van der Pal
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irma W E M van Dijk
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Flora E van Leeuwen
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rita E Weathers
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leslie L Robison
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory T Armstrong
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yutaka Yasui
- Eric J. Chow Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Yan Chen, University of Alberta, Edmonton, Alberta, Canada; Melissa M. Hudson, Daniel M. Green, Daniel A. Mulrooney, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, and Yutaka Yasui, St Jude Children's Research Hospital; Daniel A. Mulrooney, University of Tennessee, Memphis, TN; Elizabeth A.M. Feijen, Leontien C. Kremer, Cécile M. Ronckers, Helena J. van der Pal, and Irma W.E.M. van Dijk, Emma Children's Hospital, Academic Medical Center; Irma W.E.M. van Dijk, Academic Medical Center; Flora E. van Leeuwen, The Netherlands Cancer Institute, Amsterdam; Leontien C. Kremer and Helena J. van der Pal, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; William L. Border and Lillian R. Meacham, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
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Belliveau JG, Bauman GS, Tay KY, Ho D, Menon RS. Initial Investigation into Microbleeds and White Matter Signal Changes following Radiotherapy for Low-Grade and Benign Brain Tumors Using Ultra-High-Field MRI Techniques. AJNR Am J Neuroradiol 2017; 38:2251-2256. [PMID: 28970242 DOI: 10.3174/ajnr.a5395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 07/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE External beam radiation therapy is a common treatment for many brain neoplasms. While external beam radiation therapy adheres to dose limits to protect the uninvolved brain, areas of high dose to normal tissue still occur. Patients treated with chemoradiotherapy can have adverse effects such as microbleeds and radiation necrosis, but few studies exist of patients treated without chemotherapy. MATERIALS AND METHODS Ten patients were treated for low-grade or benign neoplasms with external beam radiation therapy only and scanned within 12-36 months following treatment with a 7T MR imaging scanner. A multiecho gradient-echo sequence was acquired and postprocessed into SWI, quantitative susceptibility mapping, and apparent transverse relaxation maps. Six patients returned for follow-up imaging approximately 18 months following their first research scan and were imaged with the same techniques. RESULTS At the first visit, 7/10 patients had microbleeds evident on SWI, quantitative susceptibility mapping, and apparent transverse relaxation. All microbleeds were within a dose region of >45 Gy. Additionally, 4/10 patients had asymptomatic WM signal changes evident on standard imaging. Further analysis with our technique revealed that these lesions were venocentric, suggestive of a neuroinflammatory process. CONCLUSIONS There exists a potential for microbleeds in patients treated with external beam radiation therapy without chemotherapy. This finding is of clinical relevance because it could be a precursor of future neurovascular disease and indicates that additional care should be taken when using therapies such as anticoagulants. Additionally, the appearance of venocentric WM lesions could be suggestive of a neuroinflammatory mechanism that has been suggested in diseases such as MS. Both findings merit further investigation in a larger population set.
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Affiliation(s)
- J-G Belliveau
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.).,Centre for Functional and Metabolic Mapping (J.-G.B., R.S.M.), Robarts Research Institute, London, Ontario, Canada
| | - G S Bauman
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.).,Oncology (G.S.B.).,London Regional Cancer Program (G.S.B.), London, Ontario, Canada
| | - K Y Tay
- Medical Imaging (K.Y.T.), University of Western Ontario, London, Ontario, Canada
| | - D Ho
- Department of Radiology (D.H.), Woodstock General Hospital, Woodstock, Ontario, Canada
| | - R S Menon
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.) .,Centre for Functional and Metabolic Mapping (J.-G.B., R.S.M.), Robarts Research Institute, London, Ontario, Canada
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A systemic literature review of neuroimaging studies in women with breast cancer treated with adjuvant chemotherapy. Contemp Oncol (Pozn) 2017; 21:6-15. [PMID: 28435392 PMCID: PMC5385474 DOI: 10.5114/wo.2017.66652] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 09/30/2016] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy-induced cognitive deficits in patients with breast cancer, predominantly in attention and verbal memory, have been observed in numerous studies. These neuropsychological findings are corroborated by the results of neuroimaging studies. The aim of this paper was to survey the reports on cerebral structural and functional alterations in women with breast cancer treated with chemotherapy (CTx). First, we discuss the host-related and disease-related mechanisms underlying cognitive impairment after CTx. We point out the direct and indirect neurotoxic effect of cytostatics, which may cause: a damage to neurons or glial cells, changes in neurotransmitter levels, deregulation of the immune system and/or cytokine release. Second, we focus on the results of neuroimaging studies on brain structure and function that revealed decreased: density of grey matter, integrity of white matter and volume of multiple brain regions, as well as their lower activation during cognitive task performance. Finally, we concentrate on compensatory mechanisms, which activate additional brain areas or neural connection to reach the premorbid cognitive efficiency.
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Kesler SR, Adams M, Packer M, Rao V, Henneghan AM, Blayney DW, Palesh O. Disrupted brain network functional dynamics and hyper-correlation of structural and functional connectome topology in patients with breast cancer prior to treatment. Brain Behav 2017; 7:e00643. [PMID: 28293478 PMCID: PMC5346525 DOI: 10.1002/brb3.643] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Several previous studies have demonstrated that cancer chemotherapy is associated with brain injury and cognitive dysfunction. However, evidence suggests that cancer pathogenesis alone may play a role, even in non-CNS cancers. METHODS Using a multimodal neuroimaging approach, we measured structural and functional connectome topology as well as functional network dynamics in newly diagnosed patients with breast cancer. Our study involved a novel, pretreatment assessment that occurred prior to the initiation of any cancer therapies, including surgery with anesthesia. We enrolled 74 patients with breast cancer age 29-65 and 50 frequency-matched healthy female controls who underwent anatomic and resting-state functional MRI as well as cognitive testing. RESULTS Compared to controls, patients with breast cancer demonstrated significantly lower functional network dynamics (p = .046) and cognitive functioning (p < .02, corrected). The breast cancer group also showed subtle alterations in structural local clustering and functional local clustering (p < .05, uncorrected) as well as significantly increased correlation between structural global clustering and functional global clustering compared to controls (p = .03). This hyper-correlation between structural and functional topologies was significantly associated with cognitive dysfunction (p = .005). CONCLUSIONS Our findings could not be accounted for by psychological distress and suggest that non-CNS cancer may directly and/or indirectly affect the brain via mechanisms such as tumor-induced neurogenesis, inflammation, and/or vascular changes, for example. Our results also have broader implications concerning the importance of the balance between structural and functional connectome properties as a potential biomarker of general neurologic deficit.
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Affiliation(s)
- Shelli R Kesler
- Department of Neuro-oncology University of Texas MD Anderson Cancer Center Houston TX USA
| | - Marjorie Adams
- Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford CA USA
| | - Melissa Packer
- Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford CA USA
| | - Vikram Rao
- Department of Neuro-oncology University of Texas MD Anderson Cancer Center Houston TX USA
| | | | - Douglas W Blayney
- Division of Medical Oncology Stanford University School of Medicine Stanford CA USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford CA USA
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Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM, Zamorano JL, Aboyans V, Achenbach S, Agewall S, Badimon L, Barón‐Esquivias G, Baumgartner H, Bax JJ, Bueno H, Carerj S, Dean V, Erol Ç, Fitzsimons D, Gaemperli O, Kirchhof P, Kolh P, Lancellotti P, Lip GYH, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Roffi M, Torbicki A, Vaz Carneiro A, Windecker S, Achenbach S, Minotti G, Agewall S, Badimon L, Bueno H, Cardinale D, Carerj S, Curigliano G, de Azambuja E, Dent S, Erol C, Ewer MS, Farmakis D, Fietkau R, Fitzsimons D, Gaemperli O, Kirchhof P, Kohl P, McGale P, Ponikowski P, Ringwald J, Roffi M, Schulz‐Menger J, Stebbing J, Steiner RK, Szmit S, Vaz Carneiro A, Windecker S. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur J Heart Fail 2016; 19:9-42. [DOI: 10.1002/ejhf.654] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37:2768-2801. [DOI: 10.1093/eurheartj/ehw211] [Citation(s) in RCA: 1498] [Impact Index Per Article: 187.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Kesler SR, Blayney DW. Neurotoxic Effects of Anthracycline- vs Nonanthracycline-Based Chemotherapy on Cognition in Breast Cancer Survivors. JAMA Oncol 2016; 2:185-92. [PMID: 26633037 DOI: 10.1001/jamaoncol.2015.4333] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Chemotherapy exposure is a known risk factor for cancer-related cognitive impairments. Anthracycline-based regimens are commonly used chemotherapies that have been shown to be associated with cognitive impairment and brain changes in clinical studies. OBJECTIVE To directly compare the effects of anthracycline and nonanthracycline regimens on cognitive status and functional brain connectivity. DESIGN, SETTING, AND PARTICIPANTS In this observational study, we retrospectively examined cognitive and resting state functional magnetic resonance imaging data acquired from 62 primary breast cancer survivors (mean [SD] age, 54.7 [8.5] years) who were more than 2 years off-therapy, on average. Twenty of these women received anthracycline-based chemotherapy as part of their primary treatment, 19 received nonanthracycline regimens, and 23 did not receive any chemotherapy. Participants were enrolled at a single academic institution (Stanford University) from 2008 to 2014, and the study analyses were performed at this time. MAIN OUTCOMES AND MEASURES Cognitive status was measured using standardized neuropsychological tests, and functional brain connectivity was evaluated using resting state functional magnetic resonance imaging with a focus on the brain's default mode network. RESULTS The anthracycline group demonstrated significantly lower verbal memory performance including immediate recall (F = 3.73; P = .03) and delayed recall (F = 11.11; P < .001) as well as lower left precuneus connectivity (F = 7.48; P = .001) compared with the other 2 groups. Patient-reported outcomes related to cognitive dysfunction (F = 7.27; P = .002) and psychological distress (F = 5.64; P = .006) were similarly elevated in both chemotherapy groups compared with the non-chemotherapy-treated controls. CONCLUSIONS AND RELEVANCE These results suggest that anthracyclines may have greater negative effects than nonanthracycline regimens on particular cognitive domains and brain network connections. Both anthracycline and nonanthracycline regimens may have nonspecific effects on other cognitive domains as well as certain patient reported outcomes. Further research is needed to identify potential methods for protecting the brain against the effects of various chemotherapeutic agents.
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Affiliation(s)
- Shelli R Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Douglas W Blayney
- Division of Medical Oncology, Stanford University School of Medicine, Stanford, California
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Cai Z, He W, Peng CY, Zhou J, Xu QL, Wu ZS. The prevalence of lacunar infarct decreases with aging in the elderly: a case-controlled analysis. Clin Interv Aging 2016; 11:733-8. [PMID: 27307719 PMCID: PMC4887063 DOI: 10.2147/cia.s108166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and purpose Lacunar infarct (LI) is well known as a heterogeneous primary disorder of cerebral small vessel. Compelling results have demonstrated that age is a risk factor to the prevalence of LI. However, the relationship between age and the prevalence of LI remains obscure. It is essential to note the relationship between age and the prevalence of LI through more clinical data. Methods A total of 3,500 patients were included in the case-controlled study. All data were collected from the Examination Center of Magnetic Resonance Imaging, Lu’an People’s Hospital from January 2014 to December 2015. A primary discharge diagnosis of LI was done, and all subjects were evaluated as retrospective data. The relationship between the risk factors and the prevalence of diabetes and the relationship between age and the prevalence of diabetes was analyzed. A chi-square test was used to analyze the associations between different variables. A one-way analysis of variance was used to test the equality of three or more means at one time by using variances. Statistical significance was defined as a P-value of <0.05. Results The one-way analysis of variance demonstrated that the prevalence of LI increased with age before 60 years and decreased with age after 69 years. The same results were found in both the male and the female subjects. These results showed that the age-related risk factors (hypertension, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking) have no relationship with the prevalence of LI on the basis of age. There is a significant difference among the different age ranges (P=0.0006). Two-tailed P-value (unpaired t-test) showed the mean significant difference between 30–39 years and 40–49 years (P=0.009) and between 70–79 years and 80–100 years (P=0.0196). F-test (to compare variances) demonstrated that the variances of the different age ranges are significantly different between 30–39 years and 40–49 years (P=0.0002), between 40–49 years and 50–59 years (P=0.0424), and between 70–79 years and 80–100 years (P=0.0003). Conclusion The age-related risk factors (hypertension, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking) have no relationship with the prevalence of LI on the basis of age. A decreasing prevalence of LI with aging occurs in the elderly, while the prevalence of LI increases with aging in the young and in adults. This investigation implicates that age is not a risk factor for LI in the elderly.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, People's Republic of China
| | - Wenbo He
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, People's Republic of China
| | - Chuan-Yong Peng
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
| | - Jin Zhou
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
| | - Qi-Lan Xu
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
| | - Zong-Shan Wu
- The Examination Center of Magnetic Resonance Imaging, the Lu'an Affiliated Hospital of Anhui Medical University, Lu'an People's Hospital, Lu'an, Anhui Province, People's Republic of China
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Cooke GE, Wetter NC, Banducci SE, Mackenzie MJ, Zuniga KE, Awick EA, Roberts SA, Sutton BP, McAuley E, Kramer AF. Moderate Physical Activity Mediates the Association between White Matter Lesion Volume and Memory Recall in Breast Cancer Survivors. PLoS One 2016; 11:e0149552. [PMID: 26915025 PMCID: PMC4767728 DOI: 10.1371/journal.pone.0149552] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022] Open
Abstract
Increased survival rates among breast cancer patients have drawn significant attention to consequences of both the presence of cancer, and the subsequent treatment-related impact on the brain. The incidence of breast cancer and the effects of treatment often result in alterations in the microstructure of white matter and impaired cognitive functioning. However, physical activity is proving to be a successful modifiable lifestyle factor in many studies that could prove beneficial to breast cancer survivors. This study investigates the link between white matter lesion volume, moderate physical activity, and cognition in breast cancer survivors following treatment compared to non-cancer age-matched controls. Results revealed that brain structure significantly predicted cognitive function via mediation of physical activity in breast cancer survivors. Overall, the study provided preliminary evidence suggesting moderate physical activity may help reduce the treatment related risks associated with breast cancer, including changes to WM integrity and cognitive impairment.
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Affiliation(s)
- Gillian E. Cooke
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Nathan C. Wetter
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Sarah E. Banducci
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Michael J. Mackenzie
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE, United States of America
| | - Krystle E. Zuniga
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, United States of America
| | - Elizabeth A. Awick
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Sarah A. Roberts
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Brad P. Sutton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Edward McAuley
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Arthur F. Kramer
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
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Zerebrale Mikroangiopathie bei Langzeitüberlebenden mit Brustkrebs. Strahlenther Onkol 2015. [DOI: 10.1007/s00066-015-0852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A study of donepezil in female breast cancer survivors with self-reported cognitive dysfunction 1 to 5 years following adjuvant chemotherapy. J Cancer Surviv 2015; 10:176-84. [PMID: 26130292 DOI: 10.1007/s11764-015-0463-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/07/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Some breast cancer survivors report cognitive difficulties greater than 1 year after chemotherapy. Acetylcholinesterase inhibitors (AChEI) may improve cognitive impairment. We conducted a randomized, placebo-controlled, pilot study to assess the feasibility of using the AChEI, donepezil, to improve subjective and objective measures of cognitive function in breast cancer survivors. METHODS Women who received adjuvant chemotherapy 1-5 years prior with current cognitive dysfunction symptoms were randomized to 5 mg of donepezil/day vs placebo for 6 weeks and if tolerated 10 mg/day for 18 weeks for a total of 24 weeks. A battery of validated measures of attention, memory, language, visuomotor skills, processing speed, executive function, and motor dexterity and speed was administered at baseline and at 24 and 36 weeks. Subjective cognitive function, fatigue, sleep, mood, and health-related quality of life were evaluated at baseline and at 12, 24, and 36 weeks. RESULTS Sixty-two patients were enrolled, 76 % completed the study, self-reported compliance was 98 %, and toxicities were minimal. At the end of treatment, the donepezil group performed significantly better than the control group on two parameters of memory-the Hopkins Verbal Learning Test -Revised (HVLT-R) Total Recall (p = 0.033) and HVLT-R Discrimination (p = 0.036). There were no significant differences on other cognitive variables or in subjective cognitive function or quality of life. CONCLUSION Accrual to this feasibility trial was robust, retention was good, compliance was excellent, and toxicities were minimal. IMPLICATIONS FOR CANCER SURVIVORS Randomized clinical trials in breast cancer survivors to improve cognitive dysfunction are feasible. A phase III trial testing the efficacy of donepezil is warranted given these pilot results.
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