Brain volume loss after cranial irradiation: a controlled comparison study between photon vs proton radiotherapy for WHO grade 2-3 gliomas.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuro-Oncology Pub Date : 2024-10-14 DOI:10.1007/s11060-024-04850-9

Melissa M Gardner, Sebastian F Winter, Franziska Stahl, Elizabeth R Gerstner, Helen A Shih, Janet Sherman, Jorg Dietrich, Michael W Parsons

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引用次数: 0

Abstract

Purpose: Radiation therapy (RT) is an integral treatment component in patients with glioma but associated with neurotoxicity. Proton RT (PRT), as compared with photon RT (XRT), reduces excess radiation to nontarget tissue. We used a retrospective method to evaluate brain imaging metrics of neurotoxicity after treatment with PRT and XRT for glioma.

Methods: We analyzed brain volume change in thirty-four patients with WHO grade 2-3 gliomas treated with either PRT (n = 17) or XRT (n = 17). Both groups were carefully matched by demographic/clinical criteria and assessed longitudinally for two years post-radiotherapy. Brain volume change was measured as ventricular volume expansion in the tumor free hemisphere (contralateral to RT target) as a proxy indicator of brain volume loss. We further assessed the impact of volumetric changes on cognition in PRT patients, who completed neuropsychological testing as part of an outcome study.

Results: We found significant ventricular volume increases in the contralesional hemisphere in both groups at two years post-RT (F(1, 31) = 18.45, p < 0.000, partial η2 = 0.373), with greater volume change observed in XRT (26.55%) vs. PRT (12.03%) (M = 12.03%, SD = 16.26; F(1,31) = 4.26, p = 0.048, partial η2 = 0.121). Although, there was no group-level change on any cognitive test in PRT treated patients, individual changes on cognitive screening, working memory, processing speed and visual memory tasks correlated with contralesional brain volume loss.

Conclusion: This study suggests progressive brain volume loss following cranial irradiation, with greater severity after XRT vs. PRT. Radiation-induced brain volume loss appears to be associated with measurable cognitive changes on an individual level. Prospective studies are warranted to validate these findings and their impacts on long-term cognitive function and quality of life. An improved understanding of the structural and functional consequences of cranial radiation is essential to develop neuroprotective strategies.

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颅脑照射后脑容量损失：针对WHO 2-3级胶质瘤的光子与质子放疗对照比较研究。

目的：放射治疗（RT）是胶质瘤患者不可或缺的治疗手段，但也会产生神经毒性。与光子放射治疗（XRT）相比，质子放射治疗（PRT）可减少对非靶组织的过量辐射。我们采用了一种回顾性方法来评估脑胶质瘤PRT和XRT治疗后神经毒性的脑成像指标：我们分析了 34 名接受 PRT（17 人）或 XRT（17 人）治疗的 WHO 2-3 级胶质瘤患者的脑容量变化。两组患者均按照人口统计学/临床标准进行了仔细配对，并在放疗后两年内进行了纵向评估。脑容量变化以无肿瘤半球（RT靶点的对侧）脑室容量的扩大作为脑容量损失的替代指标。我们进一步评估了体积变化对 PRT 患者认知能力的影响，这些患者完成了神经心理学测试，作为结果研究的一部分：结果：我们发现，RT 术后两年时，两组患者对侧大脑半球的脑室容积均有明显增加（F（1，31）= 18.45，P 结论：PRT 术后两年，两组患者对侧大脑半球的脑室容积均有明显增加：这项研究表明，颅脑照射后脑容量会逐渐减少，XRT 与 PRT 相比更为严重。辐射引起的脑容量损失似乎与个体水平上可测量的认知变化有关。需要进行前瞻性研究来验证这些发现及其对长期认知功能和生活质量的影响。进一步了解颅脑辐射的结构和功能后果对于制定神经保护策略至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.