Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933
Purpose: NRG Oncology's RTOG 0933 demonstrated benefits to memory preservation after hippocampal avoidant whole-brain radiation therapy (HA-WBRT), the avoidance of radiation dose to the hippocampus (using intensity modulated radiation planning and delivery techniques) during WBRT, supporting th...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-10-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109419300909 |
| _version_ | 1818996625347969024 |
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| author | Joseph A. Bovi, MD Stephanie L. Pugh, PhD David Sabsevitz, PhD Clifford G. Robinson, MD Eric Paulson, PhD Minesh P. Mehta, MD Vinai Gondi, MD Vijayananda Kundapur, MD Mark S. Shahin, MD Samuel T. Chao, MD Mitch Machtay, MD Albert S. DeNittis, MD Nadia N. Laack, MD Jeffrey N. Greenspoon, MD Kathleen N. Moore, MD Jiayi Huang, MD Michael M. Dominello, DO Lisa A. Kachnic, MD |
| author_facet | Joseph A. Bovi, MD Stephanie L. Pugh, PhD David Sabsevitz, PhD Clifford G. Robinson, MD Eric Paulson, PhD Minesh P. Mehta, MD Vinai Gondi, MD Vijayananda Kundapur, MD Mark S. Shahin, MD Samuel T. Chao, MD Mitch Machtay, MD Albert S. DeNittis, MD Nadia N. Laack, MD Jeffrey N. Greenspoon, MD Kathleen N. Moore, MD Jiayi Huang, MD Michael M. Dominello, DO Lisa A. Kachnic, MD |
| author_sort | Joseph A. Bovi, MD |
| collection | DOAJ |
| description | Purpose: NRG Oncology's RTOG 0933 demonstrated benefits to memory preservation after hippocampal avoidant whole-brain radiation therapy (HA-WBRT), the avoidance of radiation dose to the hippocampus (using intensity modulated radiation planning and delivery techniques) during WBRT, supporting the hypothesis of hippocampal radiosensitivity and associated memory specificity. However, some patients demonstrated cognitive decline, suggesting mechanisms outside hippocampal radiosensitivity play a role. White matter injury (WMI) has been implicated in radiation therapy–induced neurocognitive decline. This secondary analysis explored the relationship between pretreatment WMI and memory after HA-WBRT. Methods and Materials: Volumetric analysis of metastatic disease burden and disease-unrelated WMI was conducted on the pretreatment magnetic resonance image. Correlational analyses were performed examining the relationship between pretreatment WMI and Hopkins Verbal Learning Test-Revised (HVLT-R) outcomes at baseline and 4 months after HA-WBRT. Results: In the study, 113 patients received HA-WBRT. Of 113 patients, 33 underwent pretreatment and 4-month posttreatment HVLT testing and pretreatment postcontrast volumetric T1 and axial T2/fluid-attenuated inversion recovery magnetic resonance imaging. Correlation was found between larger volumes of pretreatment WMI and decline in HVLT-R recognition (r = 0.54, P < .05), and a correlational trend was observed between larger volume of pretreatment WMI and decline in HVLT-R delayed recall (r = 0.31, P = .08). Patients with higher pretreatment disease burden experienced a greater magnitude of stability or positive shift in HVLT-R recall and delayed recall after HA-WBRT (r = –0.36 and r = –0.36, P < .05), compared to the magnitude of stability or positive shift in those with lesser disease burden. Conclusions: In patients receiving HA-WBRT for brain metastases, extent of pretreatment WMI predicts posttreatment memory decline, suggesting a mechanism for radiation therapy–induced neurocognitive toxicity independent of hippocampal stem cell radiosensitivity. Stability or improvement in HVLT after HA-WBRT for patients with higher pretreatment intracranial metastatic burden supports the importance of WBRT-induced intracranial control on neurocognition. |
| first_indexed | 2024-12-20T21:32:43Z |
| format | Article |
| id | doaj.art-c9662f62dac04e8fb0122e9415a29190 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-20T21:32:43Z |
| publishDate | 2019-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-c9662f62dac04e8fb0122e9415a291902022-12-21T19:26:00ZengElsevierAdvances in Radiation Oncology2452-10942019-10-0144579586Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933Joseph A. Bovi, MD0Stephanie L. Pugh, PhD1David Sabsevitz, PhD2Clifford G. Robinson, MD3Eric Paulson, PhD4Minesh P. Mehta, MD5Vinai Gondi, MD6Vijayananda Kundapur, MD7Mark S. Shahin, MD8Samuel T. Chao, MD9Mitch Machtay, MD10Albert S. DeNittis, MD11Nadia N. Laack, MD12Jeffrey N. Greenspoon, MD13Kathleen N. Moore, MD14Jiayi Huang, MD15Michael M. Dominello, DO16Lisa A. Kachnic, MD17Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin; Corresponding author.NRG Oncology Statistics and Data Management Center, Philadelphia, PennsylvaniaDepartment of Psychiatry and Psychology, Department of Neurosurgery, Mayo Clinic, Jacksonville, FloridaDepartment of Radiation Oncology, Washington University School of Medicine, St. Louis, MissouriDepartment of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, WisconsinDepartment of Radiation Oncology, Baptist Hospital of Miami, Miami, FloridaDepartment of Radiation Oncology, Northwestern Medicine Cancer Center Warrenville and Northwestern University Feinberg School of Medicine, Chicago, IllinoisDepartment of Radiation Oncology, Cross Cancer Institute, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaThomas Jefferson University Hospital, Abington Memorial Hospital, Gynecologic Oncology, Abington, PennsylvaniaDepartment of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OhioDepartment of Radiation Oncology, University Hospitals of Cleveland, Case Western Reserve, Cleveland, OhioDepartment of Radiation Oncology, Main Line CCOP Lankenau Medical Center, Philadelphia, PennsylvaniaDepartment of Radiation Oncology, Mayo Clinic, Rochester, MinnesotaDivision of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton Ontario, CanadaUniversity of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OklahomaDepartment of Radiation Oncology, Washington University School of Medicine, St. Louis, MissouriDivision of Radiation Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MichiganDepartment of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TennesseePurpose: NRG Oncology's RTOG 0933 demonstrated benefits to memory preservation after hippocampal avoidant whole-brain radiation therapy (HA-WBRT), the avoidance of radiation dose to the hippocampus (using intensity modulated radiation planning and delivery techniques) during WBRT, supporting the hypothesis of hippocampal radiosensitivity and associated memory specificity. However, some patients demonstrated cognitive decline, suggesting mechanisms outside hippocampal radiosensitivity play a role. White matter injury (WMI) has been implicated in radiation therapy–induced neurocognitive decline. This secondary analysis explored the relationship between pretreatment WMI and memory after HA-WBRT. Methods and Materials: Volumetric analysis of metastatic disease burden and disease-unrelated WMI was conducted on the pretreatment magnetic resonance image. Correlational analyses were performed examining the relationship between pretreatment WMI and Hopkins Verbal Learning Test-Revised (HVLT-R) outcomes at baseline and 4 months after HA-WBRT. Results: In the study, 113 patients received HA-WBRT. Of 113 patients, 33 underwent pretreatment and 4-month posttreatment HVLT testing and pretreatment postcontrast volumetric T1 and axial T2/fluid-attenuated inversion recovery magnetic resonance imaging. Correlation was found between larger volumes of pretreatment WMI and decline in HVLT-R recognition (r = 0.54, P < .05), and a correlational trend was observed between larger volume of pretreatment WMI and decline in HVLT-R delayed recall (r = 0.31, P = .08). Patients with higher pretreatment disease burden experienced a greater magnitude of stability or positive shift in HVLT-R recall and delayed recall after HA-WBRT (r = –0.36 and r = –0.36, P < .05), compared to the magnitude of stability or positive shift in those with lesser disease burden. Conclusions: In patients receiving HA-WBRT for brain metastases, extent of pretreatment WMI predicts posttreatment memory decline, suggesting a mechanism for radiation therapy–induced neurocognitive toxicity independent of hippocampal stem cell radiosensitivity. Stability or improvement in HVLT after HA-WBRT for patients with higher pretreatment intracranial metastatic burden supports the importance of WBRT-induced intracranial control on neurocognition.http://www.sciencedirect.com/science/article/pii/S2452109419300909 |
| spellingShingle | Joseph A. Bovi, MD Stephanie L. Pugh, PhD David Sabsevitz, PhD Clifford G. Robinson, MD Eric Paulson, PhD Minesh P. Mehta, MD Vinai Gondi, MD Vijayananda Kundapur, MD Mark S. Shahin, MD Samuel T. Chao, MD Mitch Machtay, MD Albert S. DeNittis, MD Nadia N. Laack, MD Jeffrey N. Greenspoon, MD Kathleen N. Moore, MD Jiayi Huang, MD Michael M. Dominello, DO Lisa A. Kachnic, MD Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933 Advances in Radiation Oncology |
| title | Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933 |
| title_full | Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933 |
| title_fullStr | Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933 |
| title_full_unstemmed | Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933 |
| title_short | Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933 |
| title_sort | pretreatment volume of mri determined white matter injury predicts neurocognitive decline after hippocampal avoidant whole brain radiation therapy for brain metastases secondary analysis of nrg oncology radiation therapy oncology group 0933 |
| url | http://www.sciencedirect.com/science/article/pii/S2452109419300909 |
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