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Zhang S, Li M, Qiu Y, Wu J, Xu X, Ma Q, Zheng Z, Lu G, Deng Z, Huang H. Enhanced VEGF secretion and blood-brain barrier disruption: Radiation-mediated inhibition of astrocyte autophagy via PI3K-AKT pathway activation. Glia 2024; 72:568-587. [PMID: 38009296 DOI: 10.1002/glia.24491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023]
Abstract
Radiation-induced damage to the blood-brain barrier (BBB) is the recognized pathological basis of radiation-induced brain injury (RBI), a side effect of head and neck cancer treatments. There is currently a lack of therapeutic approaches for RBI due to the ambiguity of its underlying mechanisms. Therefore, it is essential to identify these mechanisms in order to prevent RBI or provide early interventions. One crucial factor contributing to BBB disruption is the radiation-induced activation of astrocytes and oversecretion of vascular endothelial growth factor (VEGF). Mechanistically, the PI3K-AKT pathway can inhibit cellular autophagy, leading to pathological cell aggregation. Moreover, it acts as an upstream pathway of VEGF. In this study, we observed the upregulation of the PI3K-AKT pathway in irradiated cultured astrocytes through bioinformatics analysis, we then validated these findings in animal brains and in vitro astrocytes following radiation exposure. Additionally, we also found the inhibition of autophagy and the oversecretion of VEGF in irradiated astrocytes. By inhibiting the PI3K-AKT pathway or promoting cellular autophagy, we observed a significant amelioration of the inhibitory effect on autophagy, leading to reductions in VEGF oversecretion and BBB disruption. In conclusion, our study suggests that radiation can inhibit autophagy and promote VEGF oversecretion by upregulating the PI3K-AKT pathway in astrocytes. Blocking the PI3K pathway can alleviate both of these effects, thereby mitigating damage to the BBB in patients undergoing radiation treatment.
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Affiliation(s)
- Shifeng Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Mingping Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yuemin Qiu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Junyu Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Xue Xu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Qian Ma
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Zhihui Zheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Gengxin Lu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Zhezhi Deng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Haiwei Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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Pan D, Shen Q, Li Y, Rong X, Li H, Xu Y, He B, Zuo X, Deng Z, Tang Y. Prognostic Value of Nutritional Assessments on Overall Survival in Head and Neck Cancer Survivors with Radiation-Induced Brain Necrosis. Nutrients 2023; 15:nu15081973. [PMID: 37111191 PMCID: PMC10141744 DOI: 10.3390/nu15081973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Malnutrition is related to worsened prognosis, but the association between nutritional risk status and overall survival in radiation-induced brain necrosis (RN) has never been studied. We included consecutive patients who had received radiotherapy for head and neck cancer (HNC) and subsequently developed RN from 8 January 2005 through to 19 January 2020. The primary outcome was overall survival. We utilized three commonly-used nutritional assessments: the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and the COntrolling NUTritional Status (CONUT) measure, to quantify the baseline nutritional risk. A total of 398 eligible patients were included. During a median follow-up of 2.3 years, 42 (10.6%) patients died of any cause. Malnutrition at admission was associated with an increased risk of future death, as assessed by the GNRI (per 1-point decreased, HR 1.05, 95%CI 1.02-1.09, p = 0.001), the PNI (per 1-point decreased, HR 1.07, 95%CI 1.03-1.12, p = 0.002), and the CONUT (per 1-point increased, HR 1.22, 95%CI 1.08-1.37, p = 0.001). There were no nonlinear correlations between all three indices and post-RN survival. Among HNC survivors with RN, the assessment of nutritional risk by composite indices upon admission could help identify patients who might be at high risk of future death and deliver better nutritional management.
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Affiliation(s)
- Dong Pan
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Honghong Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Baixuan He
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xuzheng Zuo
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhenhong Deng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou 510080, China
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Pan D, Rong X, Chen D, Jiang J, Ng WT, Mai H, Li Y, Li H, Cai J, Cheng J, Xu Y, Chua MLK, Simone CB, Lattanzi S, Tang Y. Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study. EClinicalMedicine 2022; 52:101618. [PMID: 36034411 PMCID: PMC9399256 DOI: 10.1016/j.eclinm.2022.101618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence of early treatment for radiation-induced brain necrosis (RN) in head and neck cancer survivors remains insufficient. This study aimed to determine whether early anti-RN treatment was associated with lower mortality. METHODS In this cohort study, we utilized data from the Study in Radiotherapy-related Nervous System Complications (NCT03908502) and Hong Kong Cancer Registry. We included consecutive patients who had received radiotherapy (RT) for head and neck cancers and had subsequently developed RN between Jan 8, 2005 and Jan 19, 2020. Patients who had tumor progression before the diagnosis of RN, underwent surgical brain necrosis lesions resection before corticosteroids and/or bevacizumab treatment, had intracranial metastases before the diagnosis of RN, lacked follow-up data, or had a follow-up period of less than three months were excluded. Individual-level data were extracted from electronic medical records of the above-mentioned registries. The primary outcome was all-cause death. The vital status of each patient was confirmed through a standardized telephone interview. We compared patients who received early treatment (initiating bevacizumab or corticosteroids treatment within three months after RN diagnosis) with patients who did not (following a "watch-and-wait" policy). FINDINGS Of 641 eligible patients, 451 patients (70·4%) received early treatment after RN diagnosis and 190 patients (29·6%) did not. Overall, 112 patients (17·5%) died, of whom 73 (16·2%) in the early treatment group and 39 (20·5%) in the watch-and-wait group, during a median follow-up of 3·87 years. The early treatment group showed a lower risk of all-cause death compared with the watch-and-wait group after adjusting for age, sex, absence or presence of neurological symptoms at baseline, RN lesion features on brain magnetic resonance imaging, history of stroke, prior tumor-related characteristics (TNM stage, RT dose and techniques, and chemotherapy), and the time interval from RT to RN (HR 0·48, 95%CI 0·30 to 0·77; p = 0·0027), and extensive sensitivity analyses yielded similar results. There was no significant difference in the effect of early treatment on post-RN survival among subgroups stratified by presence or absence of neurological symptoms at diagnosis (p for interaction=0·41). INTERPRETATION Among head and neck cancer survivors with RN, initiating treatment early after RN diagnosis is associated with a lower risk of all-cause mortality as compared with following the watch-and-wait policy, irrespective of whether patients exhibit symptoms or not. Further prospective randomised studies would be needed to validate our findings since the observational study design might lead to some potential confounding. In the absence of data from randomised trials, our study will have an important implication for clinicians regarding the optimal timing of treatment for RN, and provides the foundation and supporting data for future trials on this topic. FUNDING National Natural Science Foundation of China (81925031, 81820108026, 81872549, 81801229, 82003389), the Science and Technology Program of Guangzhou (202007030001), Young Teacher Training Program of Sun Yat-sen University (20ykpy106), Key-Area Research and Development Program of Guangdong Province (2018B030340001), the National Medical Research Council Singapore Clinician Scientist Award (NMRC/CSA-INV/0027/2018, CSAINV20nov-0021), the Duke-NUS Oncology Academic Program Goh Foundation Proton Research Programme, NCCS Cancer Fund, the Kua Hong Pak Head and Neck Cancer Research Programme, and the National Research Foundation Clinical Research Programme Grant (NRF-CRP17-2017-05).
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Affiliation(s)
- Dong Pan
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongping Chen
- The 5th Ward of Radiotherapy Department, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Jingru Jiang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Haiqiang Mai
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Honghong Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinping Cheng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore, Singapore
- Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Charles B. Simone
- Department of Radiation Oncology, New York Proton Centre and Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Italy
| | - Yamei Tang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, China
- Corresponding author at: Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Xi Rd., Guangzhou, Guangdong Province 510120, China.
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Chen M, Wang L, Gong G, Yin Y, Wang P. Quantitative study of the changes in brain white matter before and after radiotherapy by applying multi-sequence MR radiomics. BMC Med Imaging 2022; 22:86. [PMID: 35562722 PMCID: PMC9101859 DOI: 10.1186/s12880-022-00816-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To analyse the changes in brain white matter before and after radiotherapy (RT) by applying multisequence MR radiomics features and to establish a relationship between the changes in radiomics features and radiation dose. Methods Eighty-eight patients with brain tumours who had undergone RT were selected in this study, and MR images (T1, T1+C, T2FLAIR, T2, DWI, and ASL) before and after RT were obtained. The brain white matter was delineated as an ROI under dose gradients of 0–5 Gy, 5–10 Gy, 10–15 Gy, 15–20 Gy, 20–30 Gy, 30–40 Gy, and 40–50 Gy. The radiomics features of each ROI were extracted, and the changes in radiomics features before and after RT for different sequences under different dose gradients were compared. Results At each dose gradient, statistically significant features of different MR sequences were mainly concentrated in three dose gradients, 5–10 Gy, 20–30 Gy, and 30–40 Gy. The T1+C sequence held the most features (66) under the 20–30 Gy dose gradient. There were 20 general features at dose gradients of 20–30 Gy, 30–40 Gy, and 40–50 Gy, and the changes in features first decreased and then increased following dose escalation. With dose gradients of 5–10 Gy and 10–15 Gy, only T1 and T2FLAIR had general features, and the rates of change were − 24.57% and − 29.32% for T1 and − 3.08% and − 10.87% for T2FLAIR, respectively. The changes showed an upward trend with increasing doses. For different MR sequences that were analysed under the same dose gradient, all sequences with 5–10 Gy, 20–30 Gy and 30–40 Gy had general features, except the T2FLAIR sequence, which was concentrated in the FirstOrder category feature, and the changes in features of T1 and T1+C were more significant than those of the other sequences. Conclusions MR radiomics features revealed microscopic changes in brain white matter before and after RT, although there was no constant dose-effect relationship for each feature. The changes in radiomics features in different sequences could reveal the radiation response of brain white matter to different doses.
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Affiliation(s)
- Mingming Chen
- College of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, China
| | - Lizhen Wang
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), 250117, Jinan, China
| | - Guanzhong Gong
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), 250117, Jinan, China
| | - Yong Yin
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), 250117, Jinan, China.
| | - Pengcheng Wang
- College of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, China.
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Pan D, Rong X, Zhu Y, Ng WT, Chen D, Li H, Xu Y, Tang Y. A novel nomogram to predict overall survival in head and neck cancer survivors with radiation-induced brain necrosis. Radiother Oncol 2022; 168:121-129. [PMID: 35121029 DOI: 10.1016/j.radonc.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/27/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The study aimed to develop and validate a novel nomogram to predict overall survival in head and neck cancer survivors following the diagnosis of radiation-induced brain necrosis (RN). MATERIALS AND METHODS We included head and neck cancer survivors with RN from a radiation complications registry study. A total of 495 eligible patients were 7:3 randomly allocated to a training cohort and an internal validation cohort. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select significant predictors of post-RN survival in the training cohort, and a multivariable Cox model was used to develop the nomogram. The performance of the nomogram was assessed using the internal validation cohort and externally validated using additional 88 RN patients. RESULTS We identified five predictors of post-RN survival using the training data: age, tumor progression before RN, lower cranial nerves injury, bilateral necrosis, and history of stroke. The nomogram showed favorable performance in the internal validation cohort (C-index 0.761, 95% CI 0.676 to 0.847) and in the external validation cohort (C-index 0.795, 95% CI 0.717 to 0.874). The decision curve analysis indicated that the nomogram was clinically useful when the probabilities of death ranging from 1% to 48% at 1 year, from 3% to 50% at 3 years, and exceeding 2% at 5 years after being diagnosed with RN. CONCLUSION In this LASSO-Cox model-based nomogram study, we developed and validated an easily applied model to predict overall survival in head and neck cancer survivors following an RN diagnosis.
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Affiliation(s)
- Dong Pan
- Radiation Injury Research Center, Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoming Rong
- Radiation Injury Research Center, Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yingying Zhu
- Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Dongping Chen
- The 5th Ward of Radiotherapy Department, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Honghong Li
- Radiation Injury Research Center, Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yongteng Xu
- Radiation Injury Research Center, Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yamei Tang
- Radiation Injury Research Center, Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, People's Republic of China.
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- Radiation Injury Research Center, Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, People's Republic of China
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Veiga MGD, Fragata I, Passos J, Alves M, Papoila AL, Salgado D. Cystlike Lesions as a Late Sequela of Radiotherapy in Pediatric Patients. AJNR Am J Neuroradiol 2021; 42:1543-1549. [PMID: 34140275 DOI: 10.3174/ajnr.a7156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects. MATERIALS AND METHODS Children treated for brain tumors during a 30-year period (n = 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models. RESULTS Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity. CONCLUSIONS Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.
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Affiliation(s)
- M G D Veiga
- From the Department of Neuroradiology (M.G.D.V., I.F.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - I Fragata
- From the Department of Neuroradiology (M.G.D.V., I.F.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - J Passos
- Department of Epidemiological Analysis and Statistics (J.P., D.S.), Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - M Alves
- Department of Neurology (J.P., D.S.), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - A L Papoila
- Department of Neurology (J.P., D.S.), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - D Salgado
- Department of Epidemiological Analysis and Statistics (J.P., D.S.), Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Mariniello G, De Liso M, Russo C, Del Vecchio W, De Divitiis O, Bruno F, Maggialetti N, Arrigoni F, Brunese L, Caranci F. Radiation-induced brain cavernomas in elderly: review of the literature and a rare case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:77-83. [PMID: 31085976 PMCID: PMC6625569 DOI: 10.23750/abm.v90i5-s.8328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/16/2022]
Abstract
Radiation-induced brain cavernomas have been mainly reported in children who underwent radiotherapy for medulloblastoma, leukemia, or low-grade glioma. Otherwise, the “de novo” appearance of a cavernoma in an elderly long-survivor patient after resection and radiotherapy of a glioblastoma is a rare event. We report the case of a 62-year-old female patient who underwent surgical resection of a right temporal glioblastoma, followed by radiation therapy of the operative field and surrounding brain and concomitant adjuvant temozolomide. Four years after the operation, a follow-up Magnetic Resonance revealed a good tumor control and a small round lesion at the superior surface of the right cerebellar hemisphere, close to the margins of the previous irradiation field. The radiological items were consistent with a cavernous angioma. Because of the small size of the malformation and the absence of related symptoms, no treatment was performed. The patient died for tumor progression 86 months after the initial operation, with unchanged cerebellar cavernoma. The occurrence of a cavernous angioma in an elderly patient after radiotherapy for brain glioblastoma is an exceptional event; the distribution of radiotherapy-induced cavernous malformations reported in current literature is presented and the mechanism of their formation is discussed. (www.actabiomedica.it)
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Neurosurgical Clinic, University of Naples Federico II, Naples, Italy.
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Crombe A, Alberti N, Gilles M, Guy A, De Roquefeuil E, Dousset V, Tourdias T. Extensive acute toxic leukoencephalopathy induced by fludarabine: two months follow-up on brain MRI. J Neuroradiol 2014; 42:127-30. [PMID: 25454396 DOI: 10.1016/j.neurad.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Amandine Crombe
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Nicolas Alberti
- Department of radiology, Saint-André hospital, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - Marion Gilles
- Department of ophtalmology, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Alexandre Guy
- Department of hematology, Haut-Leveque hospital, 1, avenue Magellan, 33600 Pessac, France
| | - Elise De Roquefeuil
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Vincent Dousset
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Thomas Tourdias
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Exceptional symmetric anterior brainstem involvement in leptomeningeal carcinomatosis. J Neuroradiol 2014; 41:279-81. [DOI: 10.1016/j.neurad.2014.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/22/2022]
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Nicolasjilwan M, Hu Y, Yan C, Meerzaman D, Holder CA, Gutman D, Jain R, Colen R, Rubin DL, Zinn PO, Hwang SN, Raghavan P, Hammoud DA, Scarpace LM, Mikkelsen T, Chen J, Gevaert O, Buetow K, Freymann J, Kirby J, Flanders AE, Wintermark M. Addition of MR imaging features and genetic biomarkers strengthens glioblastoma survival prediction in TCGA patients. J Neuroradiol 2014; 42:212-21. [PMID: 24997477 DOI: 10.1016/j.neurad.2014.02.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of our study was to assess whether a model combining clinical factors, MR imaging features, and genomics would better predict overall survival of patients with glioblastoma (GBM) than either individual data type. METHODS The study was conducted leveraging The Cancer Genome Atlas (TCGA) effort supported by the National Institutes of Health. Six neuroradiologists reviewed MRI images from The Cancer Imaging Archive (http://cancerimagingarchive.net) of 102 GBM patients using the VASARI scoring system. The patients' clinical and genetic data were obtained from the TCGA website (http://www.cancergenome.nih.gov/). Patient outcome was measured in terms of overall survival time. The association between different categories of biomarkers and survival was evaluated using Cox analysis. RESULTS The features that were significantly associated with survival were: (1) clinical factors: chemotherapy; (2) imaging: proportion of tumor contrast enhancement on MRI; and (3) genomics: HRAS copy number variation. The combination of these three biomarkers resulted in an incremental increase in the strength of prediction of survival, with the model that included clinical, imaging, and genetic variables having the highest predictive accuracy (area under the curve 0.679±0.068, Akaike's information criterion 566.7, P<0.001). CONCLUSION A combination of clinical factors, imaging features, and HRAS copy number variation best predicts survival of patients with GBM.
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Affiliation(s)
- Manal Nicolasjilwan
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Ying Hu
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Chunhua Yan
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Daoud Meerzaman
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Chad A Holder
- Department of Radiology and Imaging Sciences Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA, United States
| | - David Gutman
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Rajan Jain
- Departments of Radiology and Neurosurgery, Henry Ford, Detroit, MI, United States
| | - Rivka Colen
- Division of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Daniel L Rubin
- Department of Radiology and Medicine (Biomedical Informatics Research), Stanford University, Stanford, CA, United States
| | - Pascal O Zinn
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Scott N Hwang
- Neuroradiology Section, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Prashant Raghavan
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Dima A Hammoud
- Radiology and Imaging Sciences, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Lisa M Scarpace
- Departments of Neurosurgery, Henry Ford, Detroit, MI, United States
| | - Tom Mikkelsen
- Departments of Neurosurgery, Henry Ford, Detroit, MI, United States
| | - James Chen
- Division of Neuroradiology, University of California, San Diego, CA, United States
| | - Olivier Gevaert
- Center for Cancer Systems Biology (CCSB) & Department of Radiology, Stanford University, Stanford, CA, United States
| | - Kenneth Buetow
- Arizona State University Life Science, Tempe, AZ, United States
| | | | - Justin Kirby
- SAIC-Frederick, Inc., Frederick, MD, United States
| | - Adam E Flanders
- Division of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Max Wintermark
- Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, United States; CHU de Vaudois, Department of Radiology, Lausanne, Switzerland.
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