Neurological imaging of brain damages after radiotherapy and/or chimiotherapy

Martino, Alice; Krainik, Alexandre; Pasteris, C.; Hoffmann, D.; Chabardès, Stéphan; Berger, François; Bas, J.F. Le; Cantin, S.; Attyé, Arnaud; Grand, Sylvie

doi:10.1016/j.neurad.2013.07.005

Cited by 10 publications

(10 citation statements)

References 76 publications

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“…The mechanisms underlying RN involve blood-brain barrier dysfunction, leakage of intravascular inflammatory cytokines, microglia overreaction and subsequent cellular damage 6 , 23 , 24 , 25 ; thus RN on brain MRI typically presents as a contrast-material enhanced white matter lesion with adjacent cerebral parenchymal edema, which if untreated would ultimately lead to cyst formation or even cerebral hernia. 10 , 18 Although some RN could be asymptomatic with mild brain edema at the early stage, the majority of them would progress and eventually become irreversible without effective interventions. Unfortunately, the risk factor leading to RN deterioration remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were included if they met the following criteria: (1) aged 18 years or older; (2) received and completed RT (+/- chemotherapy if applicable) for histologically confirmed head and neck cancers; (3) had radiographic evidence to support the diagnosis of RN after RT without tumor recurrence or metastases. 18 We excluded patients who: (1) had tumor progression before the diagnosis of RN; (2) underwent surgical brain necrosis lesions resection before corticosteroids and/or bevacizumab treatment; (3) had intracranial metastases before the diagnosis of RN; (4) had unavailable follow-up data; (5) had a follow-up period of less than three months (died within three months or lost to follow-up). The diagnosis of RN was based on opinions from both neurologists and radiologists, and diagnostic criteria were as follows: (1) history of RT for head and neck cancer; (2) typical radiographic change of a high-intensity lesion on fluid-attenuated inversion recovery (FLAIR) imaging and a lesion of enhancement on post-gadolinium imaging, especially “soap bubble” or “Swiss cheese” enhancement 19 ; (3) a radiographic lesion occurring in the radiation field; (4) irrespective of whether the patients exhibit neurological symptoms or not.…”

Section: Methodsmentioning

confidence: 99%

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Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study

et al. 2022

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“…Most scientific literature has classically described children's radiation therapy brain toxicity as a replication of the adult toxicity, but with increased incidence and/or severity of the adverse effects. 3,15 The vulnerability of developing tissues to radiation determines a range of adverse events in children, different from those seen in the adult population. 16 The reviews of neuroimaging findings in pediatric cancer survivors include brain volume loss, leukoencephalopathy, mineralizing microangiopathy, microbleeds, and cavernomas.…”

Section: Discussionmentioning

confidence: 99%

“…16 The reviews of neuroimaging findings in pediatric cancer survivors include brain volume loss, leukoencephalopathy, mineralizing microangiopathy, microbleeds, and cavernomas. 1,3,15 However, in previous literature reviews, CLL [9][10][11] have not been mentioned as RT adverse effects in the pediatric brain. 1,3,15 To the present date, only 3 studies have been published relating to these types of late-induced lesions from radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,15 However, in previous literature reviews, CLL [9][10][11] have not been mentioned as RT adverse effects in the pediatric brain. 1,3,15 To the present date, only 3 studies have been published relating to these types of late-induced lesions from radiation therapy. [9][10][11] The first, the only one in the Western population, was published in 2000 and included the largest number of patients.…”

Section: Discussionmentioning

confidence: 99%

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Cystlike Lesions as a Late Sequela of Radiotherapy in Pediatric Patients

Veiga

Fragata

Passos

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects. MATERIALS AND METHODS:Children treated for brain tumors during a 30-year period (n ¼ 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models.RESULTS: Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity.CONCLUSIONS: Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.ABBREVIATIONS: CLL ¼ cystlike lesions; LE ¼ leukoencephalopathy; MTX ¼ methotrexate; RT ¼ radiotherapy C entral nervous system tumors are the most common solid tumors in children, accounting for up to 22% of tumors in patients between 0 and 14 years of age. 1 The 5-year relative cancer survival rate in these patients has been increasing in the past decades. 2 Childhood cancer therapy causes chronic health problems in almost 75% of survivors, which can become clinically visible several years after treatment and are frequently irreversible and progressive. 1

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Enhanced VEGF secretion and blood–brain barrier disruption: Radiation‐mediated inhibition of astrocyte autophagy via PI3K‐AKT pathway activation

Zhang,

Li,

Qiu

et al. 2023

Glia

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Radiation‐induced damage to the blood–brain barrier (BBB) is the recognized pathological basis of radiation‐induced brain injury (RBI), a side effect of head and neck cancer treatments. There is currently a lack of therapeutic approaches for RBI due to the ambiguity of its underlying mechanisms. Therefore, it is essential to identify these mechanisms in order to prevent RBI or provide early interventions. One crucial factor contributing to BBB disruption is the radiation‐induced activation of astrocytes and oversecretion of vascular endothelial growth factor (VEGF). Mechanistically, the PI3K‐AKT pathway can inhibit cellular autophagy, leading to pathological cell aggregation. Moreover, it acts as an upstream pathway of VEGF. In this study, we observed the upregulation of the PI3K‐AKT pathway in irradiated cultured astrocytes through bioinformatics analysis, we then validated these findings in animal brains and in vitro astrocytes following radiation exposure. Additionally, we also found the inhibition of autophagy and the oversecretion of VEGF in irradiated astrocytes. By inhibiting the PI3K‐AKT pathway or promoting cellular autophagy, we observed a significant amelioration of the inhibitory effect on autophagy, leading to reductions in VEGF oversecretion and BBB disruption. In conclusion, our study suggests that radiation can inhibit autophagy and promote VEGF oversecretion by upregulating the PI3K‐AKT pathway in astrocytes. Blocking the PI3K pathway can alleviate both of these effects, thereby mitigating damage to the BBB in patients undergoing radiation treatment.

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Neurological imaging of brain damages after radiotherapy and/or chimiotherapy

Cited by 10 publications

References 76 publications

Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study

Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study

Cystlike Lesions as a Late Sequela of Radiotherapy in Pediatric Patients

Enhanced VEGF secretion and blood–brain barrier disruption: Radiation‐mediated inhibition of astrocyte autophagy via PI3K‐AKT pathway activation

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