Dose-dependent volume loss in subcortical deep grey matter structures after cranial radiotherapy

Nagtegaal, S.; Dávid, Szabolcs; Philippens, M.E.P.; Snijders, Tom J.; Leemans, Alexander; Verhoeff, Joost J.C.

doi:10.1016/j.ctro.2020.11.005

Cited by 24 publications

(22 citation statements)

References 43 publications

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“…in animal studies ( 7 ). These results are in line with the data of Nagtegaal et al., who found a dose-dependent increase in hippocampal age of 2–20 years and a hippocampal volume loss rate of 0.16%/Gy in 33 patients having undergone RT for grade II–IV glioma ( 35 ). Compared to this, the atrophy rate obtained for our HA-WBRT cohort was slightly higher (1.6% versus 0.16 × 6.8 Gy = 1.1%).…”

Section: Discussionsupporting

confidence: 92%

Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume

et al. 2021

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Background and PurposeWith improved life expectancy, preventing neurocognitive decline after cerebral radiotherapy is gaining more importance. Hippocampal damage has been considered the main culprit for cognitive deficits following conventional whole-brain radiation therapy (WBRT). Here, we aimed to determine to which extent hippocampus-avoidance WBRT (HA-WBRT) can prevent hippocampal atrophy compared to conventional WBRT.Methods and MaterialsThirty-five HA-WBRT and 48 WBRT patients were retrospectively selected, comprising a total of 544 contrast-enhanced T1-weighted magnetic resonance imaging studies, longitudinally acquired within 24 months before and 48 months after radiotherapy. HA-WBRT patients were treated analogously to the ongoing HIPPORAD-trial (DRKS00004598) protocol with 30 Gy in 12 fractions and dose to 98% of the hippocampus ≤ 9 Gy and to 2% ≤ 17 Gy. WBRT was mainly performed with 35 Gy in 14 fractions or 30 Gy in 10 fractions. Anatomical images were segmented and the hippocampal volume was quantified using the Computational Anatomy Toolbox (CAT), including neuroradiological expert review of the segmentations.ResultsAfter statistically controlling for confounding variables such as age, gender, and total intracranial volume, hippocampal atrophy was found after both WBRT and HA-WBRT (p < 10−6). However, hippocampal decline across time following HA-WBRT was approximately three times lower than following conventional WBRT (p < 10−6), with an average atrophy of 3.1% versus 8.5% in the first 2 years after radiation therapy, respectively.ConclusionHA-WBRT is a therapeutic option for patients with multiple brain metastases, which can effectively and durably minimize hippocampal atrophy compared to conventional WBRT.

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Section: Discussionsupporting

confidence: 92%

Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume

et al. 2021

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“…Indeed, recent data suggests that radiation to the thalamus may lead to executive function and processing speed decline [34]. For the thalamus and the amygdala, a dosedependent volume loss after radiotherapy was also observed [35]. Moreover, injuries to the corpus callosum were recently shown to be associated with attention/processing speed decline after radiotherapy [30,31].…”

Section: Discussionmentioning

confidence: 99%

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Eekers

Perri

Roelofs

et al. 2021

Radiotherapy and Oncology

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“…Advances in imaging techniques have allowed the examination of the precise morphological changes in the brain after RT. Changes of white matter (WM) [3], cerebral cortex [4][5][6][7], and subcortical grey matter (GM) structures [8][9][10] have already been linked to received dose in several studies. However, these investigations have focused on specific parts or structures of the brain, which may limit the generalizability of the acquired knowledge.…”

Section: Introductionmentioning

confidence: 99%

Morphological changes after cranial fractionated photon radiotherapy: Localized loss of white matter and grey matter volume with increasing dose

Nagtegaal

Dávid

Grinsven

et al. 2021

Clinical and Translational Radiation Oncology

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Numerous brain MR imaging studies have been performed to understand radiation-induced cognitive decline. However, many of them focus on a single region of interest, e.g. cerebral cortex or hippocampus. In this study, we use deformation-based morphometry (DBM) and voxel-based morphometry (VBM) to measure the morphological changes in patients receiving fractionated photon RT, and relate these to the dose. Additionally, we study tissue specific volume changes in white matter (WM), grey matter (GM), cerebrospinal fluid and total intracranial volume (TIV). Methods and materials: From our database, we selected 28 patients with MRI of high quality available at baseline and 1 year after RT. Scans were rigidly registered to each other, and to the planning CT and dose file. We used DBM to study non-tissue-specific volumetric changes, and VBM to study volume loss in grey matter. Observed changes were then related to the applied radiation dose (in EQD2). Additionally, brain tissue was segmented into WM, GM and cerebrospinal fluid, and changes in these volumes and TIV were tested. Results: Performing DBM resulted in clusters of dose-dependent volume loss 1 year after RT seen throughout the brain. Both WM and GM were affected; within the latter both cerebral cortex and subcortical nuclei show volume loss. Volume loss rates ranging from 5.3 to 15.3%/30 Gy were seen in the cerebral cortical regions in which more than 40% of voxels were affected. In VBM, similar loss rates were seen in the cortex and nuclei. The total volume of WM and GM significantly decreased with rates of 5.8% and 2.1%, while TIV remained unchanged as expected. Conclusions: Radiotherapy is associated with dose-dependent intracranial morphological changes throughout the entire brain. Therefore, we will consider to revise sparing of organs at risk based on future cognitive and neurofunctional data.

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Dose-dependent volume loss in subcortical deep grey matter structures after cranial radiotherapy

Cited by 24 publications

References 43 publications

Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume

Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Morphological changes after cranial fractionated photon radiotherapy: Localized loss of white matter and grey matter volume with increasing dose

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