Journal Article

Retrospective study of late radiation-induced damages after focal radiotherapy for childhood brain tumors

Mainardi, Luca, Verderio, Paolo, Pecori, Emilia, Arrigoni, Filippo, Pignoli, Emanuele, Diletto, Barbara, Lecchi, Mara, Spreafico, Filippo, Peruzzo, Denis, Schiavello, Elisabetta, Massimino, Maura, Oprandi, Maria C., Meroni, Silvia, Biassoni, Veronica, Montin, Eros, Alessandro, Ombretta, Bologna, Marco, Gandola, Lorenza, Cavatorta, Claudia, Poggi, Geraldina

2021

Overview

To study a robust and reproducible procedure to investigate a relation between focal brain radiotherapy (RT) low doses, neurocognitive impairment and late White Matter and Gray Matter alterations, as shown by Diffusion Tensor Imaging (DTI), in children. Forty-five patients (23 males and 22 females, median age at RT 6.2 years, median age at evaluations 11.1 years) who had received focal RT for brain tumors were recruited for DTI exams and neurocognitive tests. Patients' brains were parceled in 116 regions of interest (ROIs) using an available segmented atlas. After the development of an ad hoc, home-made, multimodal and highly deformable registration framework, we collected mean RT doses and DTI metrics values for each ROI. The pattern of association between cognitive scores or domains and dose or DTI values was assessed in each ROI through both considering and excluding ROIs with mean doses higher than 75% of the prescription. Subsequently, a preliminary threshold value of dose discriminating patients with and without neurocognitive impairment was selected for the most relevant associations. The workflow allowed us to identify 10 ROIs where RT dose and DTI metrics were significantly associated with cognitive tests results (p<0.05). In 5/10 ROIs, RT dose and cognitive tests were associated with p<0.01 and preliminary RT threshold dose values, implying a possible cognitive or neuropsychological damage, were calculated. The analysis of domains showed that the most involved one was the \"school-related activities\". This analysis, despite being conducted on a retrospective cohort of children, shows that the identification of critical brain structures and respective radiation dose thresholds is achievable by combining, with appropriate methodological tools, the large amount of data arising from different sources. This supported the design of a prospective study to gain stronger evidence.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Algorithms / Auroral kilometric radiation / Bioengineering / Bioinformatics / Biology and Life Sciences / Brain cancer / Brain damage / Brain tumors / Care and treatment / Childhood / Children / Cognition / Cognitive ability / Cognitive impairment / Complications / Computed tomography / Computer programs / Correlation analysis / Diagnosis / Dosage and administration / Editing / Electronics / Enrollments / Guardians / Health physics / Health services / Magnetic resonance imaging / Medical imaging / Medicine and Health Sciences / Methodology / Methods / Neuroimaging / Neurotoxicity / Oncology / Patient outcomes / Patients / Pediatrics / Physics / Planning / Quality of life / Radiation / Radiation damage / Radiation dosage / Radiation effects / Radiation therapy / Radiotherapy / Registration / Rehabilitation / Research and Analysis Methods / Risk analysis / Risk factors / Social Sciences / Software / Testing / Tumors / Tumors in children / Workflow