Effect of ionizing radiation on the human brain: White matter and gray matter T1 in pediatric brain tumor patients treated with conformal radiation therapy

Steen, R. Grant; B.S, Matthew Koury; Granja, Carlos; Xiong, Xioping; Wu, Shengjie; Glass, John O.; Mulhern, Raymond K.; Kun, Larry E.; Merchant, Thomas E.

doi:10.1016/s0360-3016(00)01351-1

Cited by 67 publications

(67 citation statements)

References 59 publications

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“…Structural changes of brain parenchyma are rarely reported, mainly because this issue has been disregarded in past and contemporary series. Newer techniques in MRI are able to precisely identify changes with respect to spatial distribution and corresponding integral dose distribution, but their role remain to be clarified [53,61,64,65,69].…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative MRI is sensitive to subtle changes below the resolution of conventional MRI. The working group of St. Jude Hospital assessed the effect of ionizing radiation to the brain in 29 pediatric patients undergoing fractionated conformal radiotherapy of brain tumors [65]. Mapping showed that white matter exposed to < 20 Gy and gray matter to < 60 Gy do not undergo pathologic changes.…”

Section: Diffuse Changes Of White Matter On Imaging (Leukoencephalopamentioning

confidence: 99%

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Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

Kortmann

Timmermann

Taylor³

et al. 2003

Strahlenther Onkol

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More studies and clear definitions of clinical endpoints such as neurocognitive and endocrinological outcome are needed in order to clarify the impact of radiation therapy on the risk of late sequelae. Presently, the strategy to postpone radiotherapy in the younger children, especially with NF, is justified to reduce the risk of late effects. These information and the contribution of tumor, surgery and chemotherapy will help to define the role of radiation therapy in the future management of childhood low-grade glioma and whether the use of highly sophisticated and expensive treatment techniques is justifiable. The recently initiated prospective study of the APRO (Pediatric Radiooncology Working Party) on documentation of dose prescription to organs at risk and the network of the GPOH to explore late effects as well as the forthcoming prospective SIOP/GPOH (International Society of Pediatric Oncology/German Society of Pediatric Oncology and Hematology) LGG 2003 trial are addressing these issues.

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Section: Discussionmentioning

confidence: 99%

Section: Diffuse Changes Of White Matter On Imaging (Leukoencephalopamentioning

confidence: 99%

Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

Kortmann

Timmermann

Taylor³

et al. 2003

Strahlenther Onkol

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“…Many studies have investigated the association between CNS-directed treatment and structural damage of the brain. Brain structural changes such as atrophy from gray and white matter loss or developmental deficits in the corpus callosum that are known to occur after CNS-directed treatments have been correlated with cognitive deficits (Macedoni-Luksic et al, 2003;Mulhern et al, 1999;Mulhern et al, 2001;Palmer et al, 2002;Reddick et al, 2003;Reddick et al, 2005;Steen et al, 2001), but the specific neural substrates of those deficits are largely unknown. Neuroimaging techniques, including functional MRI (fMRI) and diffusion tensor imaging (DTI), are promising new tools to investigate brain structure and function in such patients Phillips et al, 2005;Ries et al, 2004;Zou et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Brain structural abnormalities in survivors of pediatric posterior fossa brain tumors: A voxel-based morphometry study using free-form deformation

et al. 2008

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Voxel-based morphometry was used to compare brain structure morphology of survivors of posterior fossa brain tumor (PFBT) with that of normal sibling controls to investigate disease-or cancer treatment-induced changes. Two different spatial normalization approaches that are available in public domain software (free-form deformation (FFD) and discrete cosine transform (DCT)) were compared for accuracy of normalization in the PFBT patients. Anatomical landmark matching demonstrated that spatial normalization was more accurate with FFD than with DCT. Voxel-based morphometry of the FFD-normalized magnetic resonance images from PFBT survivors and sibling controls detected reduced gray matter density in the thalamus and entorhinal cortex and reduced white matter density in the internal capsule, hypothalamus, corpus callosum, and cuneus of the occipital lobe in the PFBT survivors. Identification of these morphologic lesions may help localize the neural substrates of disease-or therapy-induced cognitive deficits in survivors of childhood cancer.

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“…Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) modality suitable for this purpose because of its superior sensitivity to microstructural integrity in cerebral white matter, which is generally more prone to radiation-induced injury than is cortical gray matter (6). Radiationinduced injury in childhood cancer survivors causes DTI-derived indices that are altered from those of healthy controls (7,8).…”

Section: Introductionmentioning

confidence: 99%

Effects of Surgery and Proton Therapy on Cerebral White Matter of Craniopharyngioma Patients

Hua

Ogg

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To determine the radiation dose-effect on the structural integrity of cerebral white matter in craniopharyngioma patients receiving surgery and proton therapy.Methods and Materials-Fifty-one patients (aged 2.1-19.3 years) with craniopharyngioma underwent surgery and proton therapy in a prospective therapeutic trial. Anatomical magnetic resonance images acquired after surgery but before proton therapy were inspected to identify white matter structures intersected by surgical corridors and catheter tracks. Longitudinal diffusion tensor imaging (DTI) was performed to measure microstructural integrity changes in cerebral white matter. Fractional anisotropy (FA) derived from DTI was statistically analyzed for 51 atlasbased white matter structures of the brain to determine radiation dose-effect. FA in surgeryaffected regions in the corpus callosum was compared to that in its intact counterpart to determine whether surgical defects affect radiation dose-effect.Results-Surgical defects were seen most frequently in the corpus callosum because of transcallosal resection of tumors and insertion of ventricular or cyst catheters. The longitudinal DTI data indicated reductions in FA 3 months after therapy, which was followed by a recovery in most white matter structures. A greater FA reduction was correlated with a higher radiation dose in 20 white matter structures, indicating a radiation dose-effect. The average FA in the surgery- Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript affected regions before proton therapy was smaller (P =0.0001) than that in their non-surgery affected counterparts with more intensified subsequent reduction of FA (P=0.0083) after therapy, suggesting that surgery accentuated the radiation dose-effect.Conclusions-DTI data suggest that mild radiation dose-effects occur in patients with craniopharyngioma receiving surgery and proton therapy. Surgical defects present at the time of proton therapy appear to accentuate the radiation dose-effect longitudinally. This study supports consideration of pre-existing surgical defects and their locations in proton therapy planning and studies of treatment effect.

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Effect of ionizing radiation on the human brain: White matter and gray matter T1 in pediatric brain tumor patients treated with conformal radiation therapy

Cited by 67 publications

References 59 publications

Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

Brain structural abnormalities in survivors of pediatric posterior fossa brain tumors: A voxel-based morphometry study using free-form deformation

Effects of Surgery and Proton Therapy on Cerebral White Matter of Craniopharyngioma Patients

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