Our results show that the tissue volume decrease depends on radiation dose delivered to the healthy hemisphere and differs between treatment modalities. In contrast, the decrease in perfusion was comparable for both irradiation modalities. We conclude that proton therapy may reduce brain-volume loss when compared to photon therapy.

In glioma patients, linac-based photon beam irradiation is a widely applied therapy, which achieves highly conformal target volume coverage, but is also known to cause side-effects to adjacent areas of healthy tissue. Apart from subjective measures, such as quality of life assessment and neurocognitive function tests, objective methods to quantify tissue damage are needed to assess this impact. Magnetic resonance imaging (MRI) is a well-established method for brain tumor diagnoses as well as assessing treatment response. In this study, we retrospectively assessed volumetric changes of gray matter (GM) and white matter (WM) in glioma patients following photon irradiation using a heterogeneous MRI-dataset obtained in routine clinical practice at different sites with imaging parameters and magnetic field strengths. We found a significant reduction in WM volume at one year (p=0.01) and two years (p=0.008) post radio(chemo)therapy whereas corresponding GM volumes did not change significantly (p=0.05 and p=0.11, respectively). More importantly, we also found large variations in the segmented tissue volumes caused by the heterogeneous MR data, thus potentially masking more subtle tissue changes over time. On the basis of these observations, we present suggestions regarding data acquisitions in future prospective MR studies to assess such volumetric changes.