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Smith AE, Slivicki RA, Hohmann AG, Crystal JD. The chemotherapeutic agent paclitaxel selectively impairs learning while sparing source memory and spatial memory. Behav Brain Res 2016; 320:48-57. [PMID: 27908748 DOI: 10.1016/j.bbr.2016.11.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
Chemotherapeutic agents are widely used to treat patients with systemic cancer. The efficacy of these therapies is undermined by their adverse side-effect profiles such as cognitive deficits that have a negative impact on the quality of life of cancer survivors. Cognitive side effects occur across a variety of domains, including memory, executive function, and processing speed. Such impairments are exacerbated under cognitive challenges and a subgroup of patients experience long-term impairments. Episodic memory in rats can be examined using a source memory task. In the current study, rats received paclitaxel, a taxane-derived chemotherapeutic agent, and learning and memory functioning was examined using the source memory task. Treatment with paclitaxel did not impair spatial and episodic memory, and paclitaxel treated rats were not more susceptible to cognitive challenges. Under conditions in which memory was not impaired, paclitaxel treatment impaired learning of new rules, documenting a decreased sensitivity to changes in experimental contingencies. These findings provide new information on the nature of cancer chemotherapy-induced cognitive impairments, particularly regarding the incongruent vulnerability of episodic memory and new learning following treatment with paclitaxel.
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Affiliation(s)
- Alexandra E Smith
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Richard A Slivicki
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Andrea G Hohmann
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States; Gill Center for Biomolecular Science, Indiana University, Bloomington, IN, United States
| | - Jonathon D Crystal
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States.
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Monje M, Dietrich J. Cognitive side effects of cancer therapy demonstrate a functional role for adult neurogenesis. Behav Brain Res 2011; 227:376-9. [PMID: 21621557 DOI: 10.1016/j.bbr.2011.05.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/24/2011] [Accepted: 05/15/2011] [Indexed: 01/18/2023]
Abstract
Cancer therapies frequently result in a spectrum of neurocognitive deficits that include impaired learning, memory, attention and speed of information processing. Damage to dynamic neural progenitor cell populations in the brain are emerging as important etiologic factors. Radiation and chemotherapy-induced damage to neural progenitor populations responsible for adult hippocampal neurogenesis and for maintenance of subcortical white matter integrity are now believed to play major roles in the neurocognitive impairment many cancer survivors experience.
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Affiliation(s)
- Michelle Monje
- Department of Neurology, Division of Child Neurology, Stanford University Medical Center, 750 Welch Road, Suite 317, Palo Alto, CA 94304, USA.
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Schellart NAM, Reits D, van der Kleij AJ, Stalpers LJA. Hyperbaric oxygen treatment improved neurophysiologic performance in brain tumor patients after neurosurgery and radiotherapy. Cancer 2011; 117:3434-44. [DOI: 10.1002/cncr.25874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 11/09/2010] [Accepted: 11/30/2010] [Indexed: 11/08/2022]
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Cognitive functioning after radiotherapy or chemoradiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010; 81:126-34. [PMID: 20708851 DOI: 10.1016/j.ijrobp.2010.05.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/28/2010] [Accepted: 05/03/2010] [Indexed: 01/14/2023]
Abstract
PURPOSE To perform a comprehensive cognitive function (CF) assessment in patients who were relapse free after curative intent radiotherapy (RT) or chemoradiotherapy for squamous cell carcinoma of the head and neck. METHODS AND MATERIALS Patients underwent neuropsychological tests to assess their objective CF; completed questionnaires to assess subjective CF, quality of life, and affect; and underwent blood tests to assess hematologic, biochemical, endocrine, and cytokine status. Retrospectively, the dosimetry of incidental radiation to the brain was determined for all patients, and the dose intensity of cisplatin was determined in those who had undergone chemoradiotherapy. RESULTS A total of 10 patients were enrolled (5 treated with radiotherapy only and 5 with radiotherapy and cisplatin). The mean time from the end of treatment was 20 months (range, 9-41). All patients were able to complete the assessment protocol. Of the 10 patients, 9 had impaired objective CF, with memory the most severely affected. The severity of memory impairment correlated significantly with the radiation dose to the temporal lobes, and impaired dexterity correlated significantly with the radiation dose to the cerebellum, suggesting that these deficits might be treatment related. Patients receiving cisplatin appeared to have poorer objective CF than patients receiving only RT, although this difference did not achieve statistical significance, likely owing to the small sample size. Consistent with the published data, objective CF did not correlate with subjective CF or quality of life. No association was found between objective CF and patients' affect, hematologic, biochemical, endocrine, and cytokine status. CONCLUSION Neuropsychological testing is feasible in squamous cell carcinoma of the head-and-neck survivors. The findings were suggestive of treatment-related cognitive dysfunction. These results warrant additional investigation.
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Krupp W, Klein C, Koschny R, Holland H, Seifert V, Meixensberger J. ASSESSMENT OF NEUROPSYCHOLOGICAL PARAMETERS AND QUALITY OF LIFE TO EVALUATE OUTCOME IN PATIENTS WITH SURGICALLY TREATED SUPRATENTORIAL MENINGIOMAS. Neurosurgery 2009; 64:40-7; discussion 47. [DOI: 10.1227/01.neu.0000336330.75381.39] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
According to current outcomes research programs, assessment of a broad spectrum of parameters, including quality of life indices, is required to adequately reflect the results of a given treatment. We performed a comprehensive evaluation in patients after supratentorial meningioma surgery in a retrospective study.
METHODS
In 91 consecutive patients, outcome was assessed in individual sessions in patients' homes an average of 15 months (standard deviation, ± 3.6 months) after surgery. The survey included tests of cognitive performance, coping strategies, satisfaction with life, and a structured interview.
RESULTS
We found a significant negative correlation between patient age and cognitive performance (P < 0.001), with a major decline beginning at the age of 55 years. Despite normal cognitive performance, 73% of younger patients (younger than 55 years) compared with 20% of older patients (P < 0.001) were not satisfied with life. As a major problem, 68% of younger patients described an inability to accept having this severe disease as a young person. Patients living as singles had a higher frequency of depressive coping (P < 0.05) and less satisfaction with life (P < 0.05).
CONCLUSION
Comprehensive evaluation after meningioma surgery is required to prevent poor long-term results after apparently successful surgery. In our study, tests and structured interviews revealed different aspects, especially concerning patient age. Because demographic variables clearly influenced satisfaction with life, evaluation of quality of life must account for these factors to improve comparison of different studies. However, prospective studies with larger cohorts and control groups are required to prove our hypotheses.
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Affiliation(s)
- Wolfgang Krupp
- Department of Neurosurgery, University of Leipzig, Leipzig, Germany
| | - Christoph Klein
- Department of Neurosurgery, University of Leipzig, Leipzig, Germany
| | | | - Heidrun Holland
- Biotechnical-Biomedical Center, University of Leipzig, Leipzig, Germany
| | - Volker Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany
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Jain N, Krull KR, Brouwers P, Chintagumpala MM, Woo SY. Neuropsychological outcome following intensity-modulated radiation therapy for pediatric medulloblastoma. Pediatr Blood Cancer 2008; 51:275-9. [PMID: 18421716 DOI: 10.1002/pbc.21580] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Combined cisplatin chemotherapy and cranial irradiation for treatment of medulloblastoma in children can cause significant ototoxicity and impair cognitive function and quality of life. We have previously demonstrated the conformal technique of intensity-modulated radiation therapy (IMRT) to reduce ototoxicity, however, it has been suggested that IMRT may increase risk of cognitive deficits compared to conventional radiation therapy (CRT). This study compared the impact of the two treatments on measures of neurocognitive functioning. PROCEDURE Twenty-five pediatric patients with medulloblastoma were treated either with CRT or IMRT. In addition they received neurocognitive assessments to evaluate long-term functional outcome. Statistical analyses between the two groups were conducted to compare levels and profiles of performance on tests not confounded with hearing loss. RESULTS When compared to CRT, children treated with IMRT did not perform more poorly on any of the measures. Both groups' mean performance was significantly lower than published norms on several of the measures employed. CONCLUSION The benefit of reduced ototoxicity with IMRT does not appear to be at the cost of a decline in nonverbal intellectual abilities, visual-spatial skills, processing speed, or fine motor dexterity when compared to CRT in children with medulloblastoma.
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Affiliation(s)
- Neelam Jain
- Learning Support Center for Child Psychology, Texas Children's Hospital, Houston, Texas, USA.
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Smee RI, Williams JR. Medulloblastomas-primitive neuroectodermal tumours in the adult population. J Med Imaging Radiat Oncol 2008; 52:72-6. [PMID: 18373831 DOI: 10.1111/j.1440-1673.2007.01915.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medulloblastomas - primitive neuroectodermal tumours are rare in adults. This review will evaluate a single centre's experience with this malignancy. The medulloblastoma - primitive neuroectodermal tumour database was evaluated for all patients aged more than 18 years who were referred for management. Relevant information from the database was abstracted to provide a descriptive record of this malignancy. Between 1977-2004 there were 11 patients referred, 1 with persistent disease and 10 were eligible, presenting with initial diagnosis. There was increased intracranial pressure in 50% of patients. Most patients had symptoms >3 months, with three having symptoms 1-3 months before diagnosis and one patient having thoracic dural metastases at presentation. Complete resection was recorded in four patients and six had 50-90% resection. All patients completed craniospinal radiotherapy (35-36 Gy at 1.8-2.0 Gy fractions) barring one patient, who died of surgical complications during his radiotherapy. Chemotherapy was given in five of the nine patients postradiotherapy. There were two posterior fossa recurrences, with associated supratentorial and extra central nervous system disease. Of the 10 primary patients 7 are alive with no evidence of disease, 2 died because of disease, with 1 intercurrent death. One patient developed a second malignancy. The outcome for adults matches that of the more common paediatric patients. Radiotherapy could control local disease even where complete resection was not achieved.
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Affiliation(s)
- R I Smee
- Department of Radiation Oncology, Prince of Wales Hospital, Sydney, NSW, Australia.
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Shim KW, Joo SY, Kim SH, Choi JU, Kim DS. Prediction of prognosis in children with medulloblastoma by using immunohistochemical analysis and tissue microarray. J Neurosurg Pediatr 2008; 1:196-205. [PMID: 18352763 DOI: 10.3171/ped/2008/1/3/196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Medulloblastoma is the most common malignant neuroepithelial tumor found in children. Several reports have described efforts to identify the prognostic significance of various patterns of pathological and immunohistochemical features in medulloblastoma, but the published data appear to be controversial. The authors therefore attempted to demonstrate these prognostic factors convincingly in a retrospective study performed in patients with medulloblastoma. METHODS The data used were obtained in 58 patients with medulloblastoma who were > 3 years of age and in whom > 1 year of follow-up was available after the maximal resection, craniospinal irradiation, and chemotherapy treatments. These assessments were performed to compare the immunohistochemical features to cellular differentiation, the proliferation index (PI), the apoptotic index (AI), and oncogenesis revealed by TrkC and c-erbB-3. In addition, the authors tried to determine the prognostic utility of these results in this tumor category. RESULTS There was no statistically significant correlation between the prognosis and the degree of cell differentiation, but a positive correlation was noted between the PI and the AI in a tumor mass. The number of cases with a PI > 10% was significantly greater in the group of tumors in patients with recurrent medulloblastoma. A close association between the PI as a continuous variable and the progression-free and overall survival was also found. Most importantly, the PI is the only significant prognostic factor for the overall survival of patients with medulloblastoma. CONCLUSIONS Therefore, the authors suggest that the PI is directly linked to the prognostic factor for medulloblastoma and that immunohistochemical staining is a potentially powerful tool for predicting the prognosis of patients with medulloblastoma.
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Affiliation(s)
- Kyu-Won Shim
- Department of Neurosurgery, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Monje M. Cranial radiation therapy and damage to hippocampal neurogenesis. ACTA ACUST UNITED AC 2008; 14:238-42. [DOI: 10.1002/ddrr.26] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Giordana MT, D'Agostino C, Pollo B, Silvani A, Ferracini R, Paiolo A, Ghiglione P, Chiò A. Anaplasia Is Rare and Does Not Influence Prognosis in Adult Medulloblastoma. J Neuropathol Exp Neurol 2005; 64:869-74. [PMID: 16215458 DOI: 10.1097/01.jnen.0000182980.64236.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Histopathologic grading based on increasing anaplasia predicts clinical behavior of pediatric medulloblastomas. The present study was aimed at grading 86 medulloblastomas of adult patients (aged 18 and older) by anaplasia and analyzing the predictive power. Nodularity, desmoplasia, nuclear size, nuclear pleomorphism, necrosis, and endothelial proliferations have been evaluated. Morphometric analysis of nuclear size was performed using the Eclipse Net program. Patients treated with standard postoperative radiotherapy (35 Gy to craniospinal axis and 50 Gy to posterior fossa) were considered for correlation with survival. Pathologic data and total survival were compared by Kaplan-Meier and logrank analysis. No correlation was found between total survival duration and individual pathologic features. Cooccurrence of nuclear pleomorphism, large nuclear diameter, microvascular proliferations, and necroses did not predict outcome. Severe nuclear pleomorphism was found in 4 of 86 cases; the only large-cell medulloblastoma was from an 18-year-old patient. Histopathologic factors have no clinical use for stratification of patients in risk groups. The histologic spectrum of medulloblastoma in adults is different from that in children.
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Spreafico F, Massimino M, Gandola L, Cefalo G, Mazza E, Landonio G, Pignoli E, Poggi G, Terenziani M, Pedrazzoli P, Siena S, Fossati-Bellani F. Survival of adults treated for medulloblastoma using paediatric protocols. Eur J Cancer 2005; 41:1304-10. [PMID: 15869875 DOI: 10.1016/j.ejca.2005.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 01/05/2005] [Accepted: 02/25/2005] [Indexed: 10/25/2022]
Abstract
We retrospectively studied 26 consecutive adults treated for medulloblastoma using paediatric protocols. Between 1987 and 2003, patients 18 years old were given adjuvant chemotherapy consisting of one of two 'paediatric' regimens (depending on the time of presentation) and craniospinal local-boost radiotherapy: regimen A (n = 12), vincristine (VCR), intrathecal and/or intravenous methotrexate and conventional radiotherapy; or regimen B (n = 11) sequencing intensive doses of multiple agents followed by hyperfractionated accelerated radiotherapy (HART). A VCR-lomustine-based maintenance followed both regimens. Three additional patients received a tailored treatment due to their impaired neurological status after surgery. The median age at diagnosis was 26 years (range 18-41 years). With a median follow-up of 46 months, 5-year disease-free and overall survival rates were 65+/-11% and 73+/-10%, respectively, for the series as a whole. All patients who received regimen B (5 of whom had metastatic Chang M2-M3 disease) are alive with no evidence of disease at 39 months. Although the number of patients is limited, our data suggest that the sandwich sequential, moderately intensive chemotherapy in combination with HART is an effective treatment for medulloblastoma in adults, and this approach seems to overcome previously-recognised risk factors.
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Affiliation(s)
- Filippo Spreafico
- Paediatric Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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Breen SL, Kehagioglou P, Usher C, Plowman PN. A comparison of conventional, conformal and intensity-modulated coplanar radiotherapy plans for posterior fossa treatment. Br J Radiol 2004; 77:768-74. [PMID: 15447964 DOI: 10.1259/bjr/67922606] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Radiotherapy of the posterior fossa for medulloblastoma treatment can induce ototoxicity, especially when combined with cisplatin chemotherapy. Sensorineural hearing loss can be severe enough to cause permanent disability, which may compromise cognitive development in paediatric patients. This study evaluates the sparing of the cochlea in conventional radiotherapy, three-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT). CT scans of three patients were used to plan posterior fossa radiotherapy using coplanar beam arrangements. The posterior fossa and the cochlea were contoured as well as other organs-at-risk (non-posterior fossa brain, lenses, optic nerves, pituitary and cervical spinal cord). Three treatment plans were compared: conventional two-dimensional treatment (parallel-opposed lateral pair); 3D-CRT (two wedged posterior oblique fields); and a four-field coplanar IMRT plan. 3D-CRT and IMRT reduced cochlear doses to less than 70% of the mean target dose. These plans also reduced dose to the non-posterior fossa brain and cervical spinal cord. IMRT showed no advantage over 3D-CRT in sparing the optic nerves and lenses, compared with 3D-CRT. Normal tissue doses were higher in both conformal techniques than in the IMRT plans. Conformal techniques reduced the dose to the cochlea, non-posterior fossa brain and cervical spinal cord. The small size and proximity to the planning target volume (PTV) of the cochlea limited the effectiveness of the IMRT plan. Coplanar 3D-CRT was judged superior to coplanar IMRT, particularly in children, because it achieved adequate sparing of the cochlea and anterior cranial structures, such as the lenses and optic nerves, without compromising the dose to the posterior fossa.
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Affiliation(s)
- S L Breen
- Radiotherapy Physics Section, Radiotherapy Department, St Bartholomew's Hospital, 25 Bartholomew Close, West Smithfield, London EC1A 7BE, UK
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Brandes AA, Paris MK. Review of the prognostic factors in medulloblastoma of children and adults. Crit Rev Oncol Hematol 2004; 50:121-8. [PMID: 15157661 DOI: 10.1016/j.critrevonc.2003.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2003] [Indexed: 11/29/2022] Open
Abstract
Medulloblastoma (MB) is rare in adults, accounting for 1% of all primary tumours of the central nervous system (CNS). Based on the assumption that the disease pattern in adults is similar to that in children, adults with medulloblastoma are treated using paediatric protocols. Thanks to progress made in recent years, long-term survival is now possible, with overall ranging from 50 to 60% at 5 years and 40 to 50% at 10 years. However, effective therapy may have devastating long-term side effects, including neuro-psychic and neuro-endocrine sequelae and cognitive dysfunction, especially in young adults. Great interest has been expressed in new biological and molecular prognostic factors, which, combined with clinical variables, may allow a more satisfactory stratification of patients.
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Affiliation(s)
- Alba A Brandes
- Medical Oncology Department, University Hospital, Via Gattamelata 64, 35100 Padova, Italy.
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Paulino AC, Narayana A, Mohideen MN, Jeswani S. Posterior fossa boost in medulloblastoma: an analysis of dose to surrounding structures using 3-dimensional (conformal) radiotherapy. Int J Radiat Oncol Biol Phys 2000; 46:281-6. [PMID: 10661333 DOI: 10.1016/s0360-3016(99)00367-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to compare three different techniques of delivering the posterior fossa boost in patients with medulloblastoma. METHODS AND MATERIALS Five patients underwent CT simulation for treatment planning of the posterior fossa boost. For each slice, the posterior fossa was contoured in addition to the cochlea, non-posterior fossa brain, pituitary gland, mandible, parotid glands, thyroid gland, pharynx, and cervical spinal cord. For each patient, plans for three techniques of delivering the posterior fossa boost were compared. Technique A utilized parallel-opposed lateral fields using bony landmarks (2-dimensional radiotherapy); the other two techniques were planned using 3-dimensional radiotherapy. Technique B utilized a pair of coplanar wedged posterior oblique beams, whereas Technique C utilized a pair of posterior oblique fields and a vertex field. Dose-volume histograms (DVH) were obtained for each of the organs contoured and for each technique and patient. The maximum, minimum, and mean dose to each organ were determined using the DVH program in our treatment planning system. RESULTS In 3 of 5 patients, the planning target volume (PTV) was not included in the treatment field with Technique A. The cochlea received 100%, 50%, and 42% of the prescribed posterior fossa dose using Techniques A, B, and C respectively. The mean dose to the non-posterior fossa brain was highest with Technique C, intermediate with Technique A, and lowest for Technique B. The mean dose to the non-posterior fossa brain with Technique B was comparable to the mean non-posterior fossa brain dose delivered using parallel-opposed lateral fields based on the CT definition of the PTV. Likewise, mean dose to the pituitary gland was lowest for Technique B. Both Techniques B and C were associated with a higher mean dose to the thyroid gland, mandible, parotid glands, and pharynx. CONCLUSIONS The use of Technique B minimized the radiotherapy dose to the cochlea, pituitary gland, and non-posterior fossa brain. Contrary to what one may expect, conformal radiotherapy using Technique B did not deliver a higher dose to the non-posterior fossa brain over standard parallel-opposed lateral fields. Other advantages of conformal techniques B and C over 2-dimensional radiotherapy are the inclusion of the PTV in all patients and a lower mean dose to the pituitary gland. The main disadvantage of conformal Techniques B and C employed in our patients is a higher mean dose to the thyroid gland and other tissues in the neck.
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Affiliation(s)
- A C Paulino
- Department of Radiotherapy, Loyola University Medical Center, Maywood, IL, USA
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Grill J, Renaux-Kieffer V, Bulteau C, Kalifa C. [Neuropsychological sequelae of children treated for brain tumors: evaluation and risk factors]. Arch Pediatr 1998; 5:167-73. [PMID: 10223139 DOI: 10.1016/s0929-693x(97)86832-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The analysis of neuropsychological sequelae in children with brain tumors is a major concern in the debate for the definition of the therapeutic strategies. The authors review the recent literature in this field in the light of their own experience at the Gustave-Roussy Institute. Three main risk factors emerge from the analysis: radiation, age and surgical complications. The need for a longitudinal evaluation in these patients is emphasized in order to plan the subsequent appropriate readaptation.
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Affiliation(s)
- J Grill
- Service d'oncologie pédiatrique, institut Gustave-Roussy, Villejuif, France
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