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Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma.

Blomstrand, Malin; Brodin, N Patrik; Munck af Rosenschöld, Per; Vogelius, Ivan R; Sánchez Merino, Gaspar; Kiil-Berthlesen, Anne; Blomgren, Klas; Lannering, Birgitta; Bentzen, Søren M and Björk, Thomas LU (2012) In Neuro-Oncology 14(7). p.882-889
Abstract
We sought to assess the feasibility and estimate the benefit of sparing the neurogenic niches when irradiating the brain of pediatric patients with medulloblastoma (MB) based on clinical outcome data. Pediatric MB survivors experience a high risk of neurocognitive adverse effects, often attributed to the whole-brain irradiation that is part of standard management. Neurogenesis is very sensitive to radiation, and limiting the radiation dose to the hippocampus and the subventricular zone (SVZ) may preserve neurocognitive function. Radiotherapy plans were created using 4 techniques: standard opposing fields, intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (IMAT), and intensity-modulated proton therapy (IMPT). Mean... (More)
We sought to assess the feasibility and estimate the benefit of sparing the neurogenic niches when irradiating the brain of pediatric patients with medulloblastoma (MB) based on clinical outcome data. Pediatric MB survivors experience a high risk of neurocognitive adverse effects, often attributed to the whole-brain irradiation that is part of standard management. Neurogenesis is very sensitive to radiation, and limiting the radiation dose to the hippocampus and the subventricular zone (SVZ) may preserve neurocognitive function. Radiotherapy plans were created using 4 techniques: standard opposing fields, intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (IMAT), and intensity-modulated proton therapy (IMPT). Mean dose to the hippocampus and SVZ (mean for both sites) could be limited to 88.3% (range, 83.6%-91.0%), 77.1% (range, 71.5%-81.3%), and 42.3% (range, 26.6%-51.2%) with IMAT, IMRT, and IMPT, respectively, while maintaining at least 95% of the prescribed dose in 95% of the whole-brain target volume. Estimated risks for developing memory impairment after a prescribed dose of 23.4 Gy were 47% (95% confidence interval [CI], 21%-69%), 44% (95% CI, 21%-65%), 41% (95% CI, 22%-60%), and 33% (95% CI, 23%-44%) with opposing fields, IMAT, IMRT, and IMPT, respectively. Neurogenic niche sparing during cranial irradiation of pediatric patients with MB is feasible and is estimated to lower the risks of long-term neurocognitive sequelae. Greatest sparing is achieved with intensity-modulated proton therapy, thus making this an attractive option to be tested in a prospective clinical trial. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Neuro-Oncology
volume
14
issue
7
pages
882 - 889
publisher
Oxford University Press
external identifiers
  • wos:000305630300008
  • pmid:22611031
  • scopus:84862892950
ISSN
1523-5866
DOI
10.1093/neuonc/nos120
language
English
LU publication?
yes
id
eac1ddab-9b99-43d8-a9bb-c5f09c351a5b (old id 2608696)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22611031?dopt=Abstract
date added to LUP
2012-06-03 20:25:50
date last changed
2017-07-30 04:51:16
@article{eac1ddab-9b99-43d8-a9bb-c5f09c351a5b,
  abstract     = {We sought to assess the feasibility and estimate the benefit of sparing the neurogenic niches when irradiating the brain of pediatric patients with medulloblastoma (MB) based on clinical outcome data. Pediatric MB survivors experience a high risk of neurocognitive adverse effects, often attributed to the whole-brain irradiation that is part of standard management. Neurogenesis is very sensitive to radiation, and limiting the radiation dose to the hippocampus and the subventricular zone (SVZ) may preserve neurocognitive function. Radiotherapy plans were created using 4 techniques: standard opposing fields, intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (IMAT), and intensity-modulated proton therapy (IMPT). Mean dose to the hippocampus and SVZ (mean for both sites) could be limited to 88.3% (range, 83.6%-91.0%), 77.1% (range, 71.5%-81.3%), and 42.3% (range, 26.6%-51.2%) with IMAT, IMRT, and IMPT, respectively, while maintaining at least 95% of the prescribed dose in 95% of the whole-brain target volume. Estimated risks for developing memory impairment after a prescribed dose of 23.4 Gy were 47% (95% confidence interval [CI], 21%-69%), 44% (95% CI, 21%-65%), 41% (95% CI, 22%-60%), and 33% (95% CI, 23%-44%) with opposing fields, IMAT, IMRT, and IMPT, respectively. Neurogenic niche sparing during cranial irradiation of pediatric patients with MB is feasible and is estimated to lower the risks of long-term neurocognitive sequelae. Greatest sparing is achieved with intensity-modulated proton therapy, thus making this an attractive option to be tested in a prospective clinical trial.},
  author       = {Blomstrand, Malin and Brodin, N Patrik and Munck af Rosenschöld, Per and Vogelius, Ivan R and Sánchez Merino, Gaspar and Kiil-Berthlesen, Anne and Blomgren, Klas and Lannering, Birgitta and Bentzen, Søren M and Björk, Thomas},
  issn         = {1523-5866},
  language     = {eng},
  number       = {7},
  pages        = {882--889},
  publisher    = {Oxford University Press},
  series       = {Neuro-Oncology},
  title        = {Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma.},
  url          = {http://dx.doi.org/10.1093/neuonc/nos120},
  volume       = {14},
  year         = {2012},
}