Arif Rashid1, Ashwin N Ram1, Wendy R Kates2, Kristin J Redmond1, Moody Wharam1, E Mark Mahone3,4, Alena Horska5, Stephanie Terezakis6. 1. Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA. 2. Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, USA. 3. Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA. 4. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA. 6. Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 North Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA. stereza1@jhmi.edu.
Abstract
PURPOSE/OBJECTIVE(S): Cranial radiation therapy (CRT) may disrupt the corpus callosum (CC), which plays an important role in basic motor and cognitive functions. The aim of this prospective longitudinal study was to assess changes in CC mid-sagittal areas, CC volumes, and performance on neuropsychological (NP) tests related to the CC in children following CRT. MATERIALS/ METHODS: Twelve pediatric patients were treated with CRT for primary brain malignancies. Thirteen age-matched healthy volunteers served as controls. Brain MRIs and NP assessment emphasizing motor dexterity, processing speed, visuomotor integration, and working memory (visual and verbal) were performed at baseline and at 6, 15, and 27 months following completion of CRT. Linear mixed effects (LME) analyses were used to evaluate patient NP performance and changes in regional CC volumes (genu, anterior body, mid-body, posterior body, and splenium) and mid-sagittal areas over time and with radiation doses, correcting for age at CRT start. RESULTS: The mean age at CRT was 9.41 (range 1.2-15.7) years. The median prescription dose was 54 (range 18-59.4) Gy. LME analysis revealed a significant decrease in overall CC volumes over time (p < 0.00001), with no overall effect of radiation dose. Analysis of individual CC regions demonstrated a significant decrease in all regional volumes over time (p < 0.00001) in patients, with no effect of radiation dose. Only in the splenium was there a trend toward a dose-dependent effect (p = 0.093). Patients had significantly reduced NP performance across visits-most notably in motor dexterity and visual working memory (both p < 0.0001). CONCLUSIONS: These prospective data demonstrate a significant decrease in CC regional volumes after CRT, with associated decline in neurocognitive function, most notably in manual dexterity, attention, and working memory. Further prospective study of larger cohorts of patients is needed to establish the relationship between CRT dose, neuroanatomical, and functional changes in the CC.
PURPOSE/OBJECTIVE(S): Cranial radiation therapy (CRT) may disrupt the corpus callosum (CC), which plays an important role in basic motor and cognitive functions. The aim of this prospective longitudinal study was to assess changes in CC mid-sagittal areas, CC volumes, and performance on neuropsychological (NP) tests related to the CC in children following CRT. MATERIALS/ METHODS: Twelve pediatric patients were treated with CRT for primary brain malignancies. Thirteen age-matched healthy volunteers served as controls. Brain MRIs and NP assessment emphasizing motor dexterity, processing speed, visuomotor integration, and working memory (visual and verbal) were performed at baseline and at 6, 15, and 27 months following completion of CRT. Linear mixed effects (LME) analyses were used to evaluate patient NP performance and changes in regional CC volumes (genu, anterior body, mid-body, posterior body, and splenium) and mid-sagittal areas over time and with radiation doses, correcting for age at CRT start. RESULTS: The mean age at CRT was 9.41 (range 1.2-15.7) years. The median prescription dose was 54 (range 18-59.4) Gy. LME analysis revealed a significant decrease in overall CC volumes over time (p < 0.00001), with no overall effect of radiation dose. Analysis of individual CC regions demonstrated a significant decrease in all regional volumes over time (p < 0.00001) in patients, with no effect of radiation dose. Only in the splenium was there a trend toward a dose-dependent effect (p = 0.093). Patients had significantly reduced NP performance across visits-most notably in motor dexterity and visual working memory (both p < 0.0001). CONCLUSIONS: These prospective data demonstrate a significant decrease in CC regional volumes after CRT, with associated decline in neurocognitive function, most notably in manual dexterity, attention, and working memory. Further prospective study of larger cohorts of patients is needed to establish the relationship between CRT dose, neuroanatomical, and functional changes in the CC.
Entities:
Keywords:
CNS tumors; Neurocognitive side effects; Neurotoxicity of therapy; Radiation therapy; Volumetric MRI
Authors: Raymond K Mulhern; Shawna L Palmer; Thomas E Merchant; Dana Wallace; Mehmet Kocak; Pim Brouwers; Kevin Krull; Murali Chintagumpala; Robyn Stargatt; David M Ashley; Vida L Tyc; Larry Kun; James Boyett; Amar Gajjar Journal: J Clin Oncol Date: 2005-08-20 Impact factor: 44.544
Authors: Wilburn E Reddick; Holly A White; John O Glass; Gregory C Wheeler; Stephen J Thompson; Amar Gajjar; Laurie Leigh; Raymond K Mulhern Journal: Cancer Date: 2003-05-15 Impact factor: 6.860
Authors: Gregory T Armstrong; Neelam Jain; Wei Liu; Thomas E Merchant; Marilyn Stovall; Deo Kumar Srivastava; James G Gurney; Roger J Packer; Leslie L Robison; Kevin R Krull Journal: Neuro Oncol Date: 2010-08-17 Impact factor: 13.029
Authors: Peter Ferrazzano; Benjamin Yeske; Jeanette Mumford; Gregory Kirk; Erin D Bigler; Katherine Bowen; Nicole O'Brien; Bedda Rosario; Sue R Beers; Paul Rathouz; Michael J Bell; Andrew L Alexander Journal: J Neurotrauma Date: 2021-02-24 Impact factor: 4.869
Authors: Minh-Phuong Huynh-Le; Michelle D Tibbs; Roshan Karunamuni; Mia Salans; Kathryn R Tringale; Anthony Yip; Michael Connor; Aaron B Simon; Lucas K Vitzthum; Anny Reyes; Anna Christina Macari; Vitali Moiseenko; Carrie R McDonald; Jona A Hattangadi-Gluth Journal: Int J Radiat Oncol Biol Phys Date: 2021-01-04 Impact factor: 8.013