Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer better preserves white matter networks compared to conventional PCI.

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY
R Colaes, J Blommaert, M Lambrecht, M B de Ruiter, P Pullens, D de Ruysscher, J Belderbos, S Sunaert, S B Schagen, S Deprez
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引用次数: 0

Abstract

Background: Hippocampal avoidance during prophylactic cranial irradiation (HA-PCI) is proposed to reduce neurocognitive decline, while preserving the benefits of PCI. We evaluated whether (HA-)PCI induces changes in white matter (WM) microstructure and whether sparing the hippocampus has an impact on preserving brain network topology. Additionally, we evaluated associations between topological metrics with hippocampal volume and neuropsychological outcomes.

Methods: In this multicenter randomized phase 3 trial (NCT01780675), small cell lung cancer (SCLC) patients underwent neuropsychological testing and diffusion tensor imaging (DTI) before, 4 months (33 PCI, 37 HA-PCI) and 1 year (19 PCI, 17 HA-PCI) after (HA-)PCI. Changes in WM microstructure were investigated using whole-brain voxel-based analysis of fractional anisotropy (FA) and mean diffusivity (MD). Both hippocampal and whole-brain graph measures were used to evaluate the topological organization of structural networks. Correlation analysis was performed to associate topological metrics with neuropsychological outcomes and hippocampal volume.

Results: Both HA-PCI and PCI were associated with decreased FA in major WM tracts, such as the corpus callosum, at 4 months and 1 year post-treatment. While these FA decreases did not differ significantly between treatment groups, only PCI demonstrated increased MD over time. Additionally, PCI showed decreased global efficiency and increased characteristic path length over time when compared to HA-PCI. Significant correlations were found between whole-brain graph measures and neuropsychological outcomes.

Conclusion: While both techniques induce important changes in the WM microstructure, HA-PCI might better preserve the topological organization of brain networks than PCI. The neuroprotective role of hippocampal sparing still needs further investigation.

与传统的PCI相比,海马避免预防性颅脑照射(HA-PCI)治疗小细胞肺癌能更好地保存白质网络。
背景:在预防性颅脑照射(HA-PCI)期间,海马回避被提议减少神经认知能力下降,同时保留PCI的益处。我们评估了HA- PCI是否会引起白质(WM)微结构的改变,以及保留海马是否对保留大脑网络拓扑结构有影响。此外,我们评估了拓扑指标与海马体积和神经心理学结果之间的关联。方法:在这项多中心随机3期试验(NCT01780675)中,小细胞肺癌(SCLC)患者在(HA-)PCI术前、术后4个月(33例,37例HA-PCI)和1年(19例,17例HA-PCI)接受神经心理测试和弥散张量成像(DTI)检查。采用基于全脑体素的分数各向异性(FA)和平均扩散率(MD)分析研究WM微结构的变化。海马体和全脑图测量被用来评估结构网络的拓扑组织。将拓扑指标与神经心理学结果和海马体积进行相关性分析。结果:在治疗后4个月和1年,HA-PCI和PCI均与主要WM束(如胼胝体)FA减少相关。虽然这些FA减少在治疗组之间没有显着差异,但随着时间的推移,只有PCI显示MD增加。此外,与HA-PCI相比,随着时间的推移,PCI的整体效率下降,特征路径长度增加。发现全脑图测量与神经心理学结果之间存在显著相关性。结论:虽然这两种方法都能引起WM微结构的重要变化,但HA-PCI可能比PCI更好地保留了脑网络的拓扑组织。海马保留的神经保护作用仍需进一步研究。
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
Neuro-oncology
Neuro-oncology 医学-临床神经学
CiteScore
27.20
自引率
6.30%
发文量
1434
审稿时长
3-8 weeks
期刊介绍: Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.
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