Neuroplastic Response After Radiation Therapy for Pediatric Brain Tumors: A Pilot Study

Armstrong, Carol L.; Fisher, Michael J.; Li, Yimei; Lustig, Robert A.; Belasco, Jean B.; Minturn, Jane E.; Hill‐Kayser, Christine; Karmakar, Saswati; Phillips, Peter C.B.

doi:10.1016/j.ijrobp.2016.01.013

Cited by 7 publications

(5 citation statements)

References 44 publications

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“…10 Normal brain was defined as the whole brain minus the gross tumor volume contour. Mean dose 11 and dose to 50% of the structure (D50) 12 were recorded.…”

Section: Neuro-oncologymentioning

confidence: 99%

Intellectual changes after radiation for children with brain tumors: which brain structures are most important?

et al. 2020

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Background The objective of this study was to evaluate the contribution of radiation dose to different intracranial structures on changes in intellectual function for children with brain tumors. Methods We evaluated children with brain tumors treated from 2005-2017 who had longitudinal neuropsychological assessments and available photon dosimetric data (if RT given). Full scale intelligence quotient (FSIQ) and index scores were evaluated (perceptual reasoning [PRI], processing speed [PSI], verbal comprehension [VCI] and working memory [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at RT and dose to different brain regions as fixed effects and patient-specific random intercepts. P-values (p*) were adjusted for multiple comparisons. Results Sixty-nine patients were included, 56 of whom received RT. Median neuropsychological follow-up was 3.2 years. Right temporal lobe mean dose was strongly associated with decline in FSIQ (p* = 0.005); with each gray increase in mean dose, there was a decrease of 0.052 FSIQ points per year. Dose to 50% (D50) of the supratentorial brain was associated with decline in PSI (p* = 0.006) and WMI (p* = 0.001). Right and left hippocampus D50 were individually strongly associated with declines in VCI (p* = 0.009 for each). Presence of ventriculoperitoneal shunt decreased FSIQ by 10 points. Conclusions We reported associations between dosimetry to specific brain regions and intellectual outcomes, with suggested avoidance structures during RT planning. These models can help clinicians anticipate changes in neurocognition post-RT and guide selection of an optimal RT plan.

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“…10 Normal brain was defined as the whole brain minus the gross tumor volume contour. Mean dose 11 and dose to 50% of the structure (D50) 12 were recorded.…”

Section: Neuro-oncologymentioning

confidence: 99%

Intellectual changes after radiation for children with brain tumors: which brain structures are most important?

et al. 2020

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“… 18 In addition, it has been demonstrated that RT-related cognitive dysfunction affects verbal and semantic long-term retrieval to a greater extent than visual-perceptual memory. 19 , 20 Therefore, it is possible that the robustness of this aspect of cognition is further enhanced in its recovery by limiting the subcortical brain irradiation with SCRT.…”

Section: Discussionmentioning

confidence: 99%

A randomized trial of stereotactic versus conventional radiotherapy in young patients with low-grade brain tumors: occupational therapy-based neurocognitive data

Chatterjee

Goda

Gupta

et al. 2020

Neuro-Oncology Advances

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Background Radiotherapy for brain tumors in young patients is not only associated with improved survival but also long-term neurocognitive sequelae. We aimed to compare group differences in the executive neurocognitive outcomes in young patients with low-grade brain tumors treated with Stereotactic Conformal Radiotherapy (SCRT) and Conventional RT(ConvRT) techniques. Methods This a phase-3 randomized trial that enrolled 200 young patients with benign brain tumors and low-grade gliomas. Patients were randomly allocated (1:1) to either SCRT or ConvRT arms and treated to a dose of 54 Gy in 30 fractions over 6 weeks. Lowenstein Occupational Therapy Cognitive Assessment battery was performed at pre-radiotherapy baseline, 6 months, and annually thereafter until 5 years. Executive functions measures included orientation, visual perception, spatial perception, motor praxis, visuomotor organization, thinking operations and attention &concentration. The trajectory of these parameters was compared between the treatment arms over 5 years. Results Two hundred patients were enrolled in the study (SCRT:104 & ConvRT:96).The median age was 13 years [IQR:9-17]; mean total neurocognitive scores over 5 years were significantly superior in SCRT arm as compared to ConvRT (difference in slope: 2.27;p = 0.024). Outcomes improved in the SCRT arm vis-à-vis ConvRT for the subdomain of visuomotor organization (difference in slope:0.66, P<0.001). Visuomotor organization scores significantly improved in majority of the sub-stratification groups. Spatial perception improved in craniopharyngioma patients with SCRT technique as opposed to ConvRT. Conclusions SCRT achieved superior outcomes compared to ConvRT in certain executive neurocognitive functional domains. We provide high level of evidence in favor of SCRT.

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“…18 White matter injury, however, may not be the only route to cognitive loss from radiation, as hippocampal injury has been observed in animal models and postulated to impact declarative memory function in humans. 14 Whereas combined white matter and hippocampal toxicity remains conceivable, clinical studies have generally demonstrated a retrieval rather than an encoding deficit, [19][20][21] a pattern more consistent with white matter injury. 14,[17][18][19][20][21] White matter injury from radiation is thus without question, but more study is needed to clarify the range of radiation effects on the brain and cognition.…”

Section: Radiationmentioning

confidence: 99%

“…14 Whereas combined white matter and hippocampal toxicity remains conceivable, clinical studies have generally demonstrated a retrieval rather than an encoding deficit, [19][20][21] a pattern more consistent with white matter injury. 14,[17][18][19][20][21] White matter injury from radiation is thus without question, but more study is needed to clarify the range of radiation effects on the brain and cognition.…”

Section: Radiationmentioning

confidence: 99%

The Expanding Prominence of Toxic Leukoencephalopathy

Filley

McConnell

Anderson

2017

JNP

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Toxic leukoencephalopathy (TL) is a disorder of brain white matter caused by exposure to leukotoxic agents. Magnetic resonance imaging (MRI) can readily identify this syndrome, and, together with diffusion tensor imaging, MRI continues to offer important insights into its nature. Since the first formal description of TL in 2001, many new leukotoxic disorders have been recognized, and the range of leukotoxins has expanded to include more therapeutic drugs, drugs of abuse, and environmental insults. While the understanding of pathophysiology remains incomplete, TL is increasingly common in clinical practice, and the potential long-term cognitive sequelae of toxic white matter injury merit attention.

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Neuroplastic Response After Radiation Therapy for Pediatric Brain Tumors: A Pilot Study

Cited by 7 publications

References 44 publications

Intellectual changes after radiation for children with brain tumors: which brain structures are most important?

Intellectual changes after radiation for children with brain tumors: which brain structures are most important?

A randomized trial of stereotactic versus conventional radiotherapy in young patients with low-grade brain tumors: occupational therapy-based neurocognitive data

The Expanding Prominence of Toxic Leukoencephalopathy

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