CNS complications of radiotherapy and chemotherapy

Soussain, Carole; Ricard, Damien; Fike, John R.; Mazeron, J.J.; Psimaras, Dimitri; Delattre, Jean‐Yves

doi:10.1016/s0140-6736(09)61299-x

Cited by 356 publications

(242 citation statements)

References 118 publications

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“…As a result, up to 50% of patients who survive long term after treatment experience progressive dementia, thus severely compromising quality of life . The available experimental data clearly demonstrate that radiation also leads to a progressive impairment of cognitive function in animal models, mimicking the clinical scenario of cognitive decline in patients after WBI (Lamproglou et al 2001;Shi et al 2006;Soussain et al 2009;Warrington et al 2012;Welzel et al 2008aWelzel et al , 2008b. Recent studies show that in addition to its profound harmful effects on cognitive function, WBI can also result in the impairment of other brain functions such as coordination of gait (Hatcher-Martin and Factor 2016).…”

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confidence: 91%

Cerebromicrovascular dysfunction predicts cognitive decline and gait abnormalities in a mouse model of whole brain irradiation-induced accelerated brain senescence

et al. 2017

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Whole brain irradiation (WBI) is a mainstream therapy for patients with both identifiable brain metastases and prophylaxis for microscopic malignancies. However, it also promotes accelerated senescence in healthy tissues and leads to progressive cognitive dysfunction in up to 50% of tumor patients surviving long term after treatment, due to γ-irradiation-induced cerebromicrovascular injury. Moment-to-moment adjustment of cerebral blood flow ( C B F ) v i a n e u r o n a l a c t i v i t y -d e p e n d e n t cerebromicrovascular dilation (functional hyperemia) has a critical role in maintenance of healthy cognitive function. To determine whether cognitive decline induced by WBI associates with impaired cerebromicrovascular function, C56BL/6 mice (3 months) subjected to a clinically relevant protocol of fractionated WBI (5 Gy twice weekly for 4 weeks) and control mice were compared. Mice were tested for spatial memory performance (radial arm water maze), sensorimotor coordination (computerized gait analysis, CatWalk), and cerebromicrovascular function (whisker-stimulation-induced increases in CBF, measured by laser Doppler flowmetry) at 3 to 6 months post-irradiation. We found that mice with WBI exhibited impaired cerebromicrovascular function at 3 months post-irradiation, which was associated with impaired performance in the radial arm water maze. At 6 months, post-irradiation progressive impairment in gait coordination (including changes in the regularity index and phase dispersion) was also evident. Collectively, our findings provide evidence for early and persisting neurovascular impairment after a clinically relevant protocol of fractionated WBI, which predict early manifestations of cognitive impairment.

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confidence: 91%

Cerebromicrovascular dysfunction predicts cognitive decline and gait abnormalities in a mouse model of whole brain irradiation-induced accelerated brain senescence

et al. 2017

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“…Usually MRI does not show the changes as in acute reactions [3]. Sometimes, T2-hyperintense area and contrast enhancement pattern not seen previously may be detected.…”

Section: Radiotherapy-induced Complicationsmentioning

confidence: 86%

Brain MRI Findings in Neurological Complications of Cancer Treatment

Cabaj¹,

Bekiesińska‐Figatowska²,

Duczkowska³

et al. 2016

Adv Clin Exp Med

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“…The underlying inflammatory mechanism is thought to result from dysfunctional astrocytes and microglia surrounding the central necrotic zone of the treated lesion [7]. These perinecrotic cells secrete inflammatory cytokines such as VEGF, TNF-α, and ICAM-1, resulting in blood-brain barrier breakdown and angiogenesis; the resultant contrast-enhancing rim apparent on imaging makes it impossible to distinguish from progressive tumor [7,27,[32][33][34]. The resulting edema promotes perilesional hypoxia, driving HIF-1α expression [35] and stimulating a VEGF feedback loop, perpetuating a cycle of edema.…”

Section: Discussionmentioning

confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

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Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

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CNS complications of radiotherapy and chemotherapy

Cited by 356 publications

References 118 publications

Cerebromicrovascular dysfunction predicts cognitive decline and gait abnormalities in a mouse model of whole brain irradiation-induced accelerated brain senescence

Cerebromicrovascular dysfunction predicts cognitive decline and gait abnormalities in a mouse model of whole brain irradiation-induced accelerated brain senescence

Brain MRI Findings in Neurological Complications of Cancer Treatment

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

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