Jayant S Goda1,2, Debnarayan Dutta1,2, Uday Krishna1,2, Savita Goswami2,3, Vikas Kothavade1, Sadhna Kannan2,4, Madan Maitre1,2, Nazia Bano1,2, Tejpal Gupta1, Rakesh Jalali1,2. 1. Neuro-Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India. 2. Homi Bhaba National Institute, Mumbai, India. 3. Clinical Psychology, Tata Memorial Centre, Parel, Mumbai, India. 4. Clinical Research Secretariat, Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, India.
Abstract
BACKGROUND: Hippocampus is considered to be the seat for neurocognitive functions. Avoidance of hippocampus during radiotherapy to brain may serve to preserve various domains of neurocognition. We aimed to derive radiotherapy dose constraints to hippocampi for preserving neurocognition in young patients with brain tumors by measuring various neurocognitive parameters. METHODS: Forty-eight patients with residual/progressive benign or low-grade brain tumors treated with stereotactic conformal radiotherapy (SCRT) to a dose of 54 Gy in 30 fractions underwent prospective neuropsychological assessments at baseline before SCRT and at 6 months and 2, 3, 4, and 5 years. Hippocampi were drawn as per the Radiation Therapy Oncology Group atlas. Longitudinal change in intelligence quotient scores was correlated with hippocampal doses. RESULTS: Mean volume of bilateral hippocampi was 4.35 cc (range: 2.12-8.41 cc). Craniopharyngioma was the commonest histologic subtype. A drop of >10% in mean full-scale intelligence quotient (FSIQ) scores at 3 and 5 years post SCRT was observed in patients in whom left hippocampus received a mean dose of 30.7 Gy (P = 0.04) and 31 Gy (P = 0.04), respectively. Mean performance quotient (PQ) scores dropped > 10% at 5 years when the left hippocampus received a dose of > 32 Gy (P = 0.03). There was no significant correlation of radiotherapy doses with verbal quotient, or with doses received by the right hippocampus. Multivariate analysis revealed young age (<13 y) and left hippocampus dose predicted for clinically relevant decline in certain neurocognitive domains. CONCLUSIONS: A mean dose of ≤30 Gy to the left hippocampus as a dose constraint for preserving intelligence quotient is suggested. KEY POINTS: 1. Children and young adults with benign and low-grade gliomas survive long after therapy.2. Higher dose to the hippocampi may result in long-term neurocognitive impairment.3. Mean dose of <30 Gy to left hippocampus could be used as a pragmatic dose constraint to prevent long-term neurocognitive decline.
BACKGROUND: Hippocampus is considered to be the seat for neurocognitive functions. Avoidance of hippocampus during radiotherapy to brain may serve to preserve various domains of neurocognition. We aimed to derive radiotherapy dose constraints to hippocampi for preserving neurocognition in young patients with brain tumors by measuring various neurocognitive parameters. METHODS: Forty-eight patients with residual/progressive benign or low-grade brain tumors treated with stereotactic conformal radiotherapy (SCRT) to a dose of 54 Gy in 30 fractions underwent prospective neuropsychological assessments at baseline before SCRT and at 6 months and 2, 3, 4, and 5 years. Hippocampi were drawn as per the Radiation Therapy Oncology Group atlas. Longitudinal change in intelligence quotient scores was correlated with hippocampal doses. RESULTS: Mean volume of bilateral hippocampi was 4.35 cc (range: 2.12-8.41 cc). Craniopharyngioma was the commonest histologic subtype. A drop of >10% in mean full-scale intelligence quotient (FSIQ) scores at 3 and 5 years post SCRT was observed in patients in whom left hippocampus received a mean dose of 30.7 Gy (P = 0.04) and 31 Gy (P = 0.04), respectively. Mean performance quotient (PQ) scores dropped > 10% at 5 years when the left hippocampus received a dose of > 32 Gy (P = 0.03). There was no significant correlation of radiotherapy doses with verbal quotient, or with doses received by the right hippocampus. Multivariate analysis revealed young age (<13 y) and left hippocampus dose predicted for clinically relevant decline in certain neurocognitive domains. CONCLUSIONS: A mean dose of ≤30 Gy to the left hippocampus as a dose constraint for preserving intelligence quotient is suggested. KEY POINTS: 1. Children and young adults with benign and low-grade gliomas survive long after therapy.2. Higher dose to the hippocampi may result in long-term neurocognitive impairment.3. Mean dose of <30 Gy to left hippocampus could be used as a pragmatic dose constraint to prevent long-term neurocognitive decline.
Authors: Vinai Gondi; Ranjini Tolakanahalli; Minesh P Mehta; Dinesh Tewatia; Howard Rowley; John S Kuo; Deepak Khuntia; Wolfgang A Tomé Journal: Int J Radiat Oncol Biol Phys Date: 2010-11-15 Impact factor: 7.038
Authors: Andrew H Zureick; Casey L Evans; Andrzej Niemierko; Julie A Grieco; Alexandra J Nichols; Barbara C Fullerton; Clayton B Hess; Claire P Goebel; Sara L Gallotto; Elizabeth A Weyman; Dillon E Gaudet; Jessica A Nartowicz; David H Ebb; Robin M Jones; Shannon M MacDonald; Nancy J Tarbell; Torunn I Yock; Margaret B Pulsifer Journal: Cancer Date: 2018-03-02 Impact factor: 6.860
Authors: M A Scott; J M Fletcher; B L Brookshire; K C Davidson; S H Landry; T C Bohan; L A Kramer; M E Brandt; D J Francis Journal: Neuropsychology Date: 1998-10 Impact factor: 3.295
Authors: Thomas E Merchant; Heather M Conklin; Shengjie Wu; Robert H Lustig; Xiaoping Xiong Journal: J Clin Oncol Date: 2009-07-06 Impact factor: 44.544
Authors: Daniëlle B P Eekers; Lieke In 't Ven; Sabine Deprez; Linda Jacobi; Erik Roelofs; Ann Hoeben; Philippe Lambin; Dirk de Ruysscher; Esther G C Troost Journal: Clin Transl Radiat Oncol Date: 2017-11-23
Authors: Sahaja Acharya; Shengjie Wu; Jason M Ashford; Christopher L Tinkle; John T Lucas; Ibrahim Qaddoumi; Amar Gajjar; Matthew J Krasin; Heather M Conklin; Thomas E Merchant Journal: Neuro Oncol Date: 2019-04-12 Impact factor: 12.300
Authors: David Y Mak; Zain Siddiqui; Zhihui Amy Liu; Hitesh Dama; Shannon M MacDonald; Shengjie Wu; Erin S Murphy; Matthew D Hall; Victor Malkov; Arzu Onar-Thomas; Sameera Ahmed; Girish Dhall; Derek S Tsang Journal: Pediatr Blood Cancer Date: 2022-04-04 Impact factor: 3.838
Authors: Melanie A Morrison; Sadie Walter; Sabine Mueller; Erin Felton; Angela Jakary; Schuyler Stoller; Annette M Molinaro; Steve E Braunstein; Christopher P Hess; Janine M Lupo Journal: Front Neurol Date: 2022-09-12 Impact factor: 4.086