Microstructural Injury to Left-Sided Perisylvian White Matter Predicts Language Decline After Brain Radiation Therapy

Tibbs, M.D.; Huynh‐Le, Minh‐Phuong; Karunamuni, Roshan; Reyes, Anny; Macari, Anna Christina; Tringale, Kathryn R.; Salans, Mia; Yip, Anthony; Liu, Eulanca Y.; Simon, Aaron B.; McDonald, Carrie R.; Hattangadi‐Gluth, Jona A.

doi:10.1016/j.ijrobp.2020.07.032

Cited by 19 publications

(8 citation statements)

References 44 publications

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“…Notably, for a D 40% < 7.4 Gy, hippocampal volumes increased. Dose-dependent brain changes were also demonstrated for white matter [39], the amygdala [40], and left-sided perisylvian white matter [41]. In our study, the hippocampi receiving less than 7.4 Gy were always contralateral hippocampus relative to the GBM, and in 7 cases, the homolateral hippocampus whom D 40% was < 7.4 Gy because the GBM was far enough away from the hippocampus and consequently, the hippocampus was not in, or near the radiation elds.…”

Section: Discussionmentioning

confidence: 86%

Role of hippocampal location and radiation dose in glioblastoma patients with hippocampal atrophy

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Xue

Loit

et al. 2021

Preprint

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Background The hippocampus is a critical organ for irradiation. Thus, we explored changes in hippocampal volume according to the dose delivered and the location relative to the glioblastoma.Methods All patients were treated for glioblastoma with surgery, concomitant radiotherapy and temozolomide, and adjuvant temozolomide. Hippocampi were retrospectively delineated on three MRIs, performed at baseline, at the time of relapse, and on the last MRI available at the end of follow-up. A total of 98, 96, and 82 hippocampi were measured in the 49 patients included in the study, respectively. The patients were stratified into three subgroups according to the dose delivered to 40% of the hippocampus. In the group 1 (n = 6), the hippocampal D40% was < 7.4 Gy, in the group 2 (n = 13), only the Hcontra D40% was < 7.4 Gy, and in the group 3 (n = 30), the D40% for both hippocampi was > 7.4 Gy.Results Regardless of the time of measurement, homolateral hippocampal volumes were significantly lower than those contralateral to the tumor. Regardless of the side, the volumes at the last MRI were significantly lower than those measured at baseline. There was a significant correlation among the decrease in hippocampal volume regardless of its side, and Dmax (p = 0.001), D98% (p = 0.028) and D40% (p = 0.0002). After adjustment for the time of MRI, these correlations remained significant. According to the D40% and volume at MRIlast, the hippocampi decreased by 4 mm3/Gy overall.Conclusions There was a significant relationship between the radiotherapy dose and decrease in hippocampal volume. However, at the lowest doses, the hippocampi seem to exhibit an adaptive increase in their volume, which could indicate a plasticity effect. Consequently, shielding at least one hippocampus by delivering the lowest possible dose is recommended so that cognitive function can be preserved.Trial registration: Retrospectively registered.

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Section: Discussionmentioning

confidence: 86%

Role of hippocampal location and radiation dose in glioblastoma patients with hippocampal atrophy

Fèvre

Xue

Loit

et al. 2021

Preprint

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show abstract

“…Notably, for a D 40% < 7.4 Gy, hippocampal volumes increased. Dose-dependent brain changes were also demonstrated for white matter [ 46 ], the amygdala [ 47 ], and left-sided perisylvian white matter [ 48 ]. In our study, the hippocampi receiving less than 7.4 Gy were always contralateral hippocampus relative to the GBM, and in 7 cases, the homolateral hippocampus whom D 40% was < 7.4 Gy because the GBM was far enough away from the hippocampus and consequently, the hippocampus was not in, or near the radiation fields.…”

Section: Discussionmentioning

confidence: 99%

Role of hippocampal location and radiation dose in glioblastoma patients with hippocampal atrophy

Fèvre

Xue

Loit³

et al. 2021

Radiat Oncol

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Background The hippocampus is a critical organ for irradiation. Thus, we explored changes in hippocampal volume according to the dose delivered and the location relative to the glioblastoma. Methods All patients were treated for glioblastoma with surgery, concomitant radiotherapy and temozolomide, and adjuvant temozolomide. Hippocampi were retrospectively delineated on three MRIs, performed at baseline, at the time of relapse, and on the last MRI available at the end of follow-up. A total of 98, 96, and 82 hippocampi were measured in the 49 patients included in the study, respectively. The patients were stratified into three subgroups according to the dose delivered to 40% of the hippocampus. In the group 1 (n = 6), the hippocampal D40% was < 7.4 Gy, in the group 2 (n = 13), only the Hcontra D40% was < 7.4 Gy, and in the group 3 (n = 30), the D40% for both hippocampi was > 7.4 Gy. Results Regardless of the time of measurement, homolateral hippocampal volumes were significantly lower than those contralateral to the tumor. Regardless of the side, the volumes at the last MRI were significantly lower than those measured at baseline. There was a significant correlation among the decrease in hippocampal volume regardless of its side, and Dmax (p = 0.001), D98% (p = 0.028) and D40% (p = 0.0002). After adjustment for the time of MRI, these correlations remained significant. According to the D40% and volume at MRIlast, the hippocampi decreased by 4 mm3/Gy overall. Conclusions There was a significant relationship between the radiotherapy dose and decrease in hippocampal volume. However, at the lowest doses, the hippocampi seem to exhibit an adaptive increase in their volume, which could indicate a plasticity effect. Consequently, shielding at least one hippocampus by delivering the lowest possible dose is recommended so that cognitive function can be preserved. Trial registration Retrospectively registered.

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“…We have found that microstructural injury, as detected by DTI, within the corpus callosum and interhemispheric WM as a whole, corresponded to decline in attention and processing speed 6 months after fractionated RT in 44 primary brain tumor patients, mostly glioma. 42 Tibbs et al 43 found that WM injury within left-sided inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and arcuate fasciculus (Fig. 6) correlated with decline in semantic fluency and naming ability, with no correlation with right-sided biomarkers.…”

Section: Diffusion Imagingmentioning

confidence: 98%

Precision Radiotherapy for Gliomas

et al. 2021

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Gliomas are the most common primary brain cancer, yet are extraordinarily challenging to treat because they can be aggressive and infiltrative, locally recurrent, and resistant to standard treatments. Furthermore, the treatments themselves, including radiation therapy, can affect patients' neurocognitive function and quality of life. Noninvasive imaging is the standard of care for primary brain tumors, including diagnosis, treatment planning, and monitoring for treatment response. This article explores the ways in which advanced imaging has and will continue to transform radiation treatment for patients with gliomas, with a focus on cognitive preservation and novel biomarkers, as well as precision radiotherapy and treatment adaptation. Advances in novel imaging techniques continue to push the field forward, to more precisely guided treatment planning, radiation dose escalation, measurement of therapeutic response, and understanding of radiation-associated injury.

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Microstructural Injury to Left-Sided Perisylvian White Matter Predicts Language Decline After Brain Radiation Therapy

Cited by 19 publications

References 44 publications

Role of hippocampal location and radiation dose in glioblastoma patients with hippocampal atrophy

Role of hippocampal location and radiation dose in glioblastoma patients with hippocampal atrophy

Role of hippocampal location and radiation dose in glioblastoma patients with hippocampal atrophy

Precision Radiotherapy for Gliomas

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