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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

Authors :
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
Source :
Advances in Radiation Oncology, Vol 4, Iss 4, Pp 579-586 (2019)
Publication Year :
2019
Publisher :
Elsevier, 2019.

Abstract

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

Details

Language :
English
ISSN :
24521094
Volume :
4
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Advances in Radiation Oncology
Publication Type :
Academic Journal
Accession number :
edsdoj.9662f62dac04e8fb0122e9415a29190
Document Type :
article
Full Text :
https://doi.org/10.1016/j.adro.2019.07.006