Journal article
Diffusion Tensor Imaging-Based Analysis of Baseline Neurocognitive Function and Posttreatment White Matter Changes in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Therapy
International journal of radiation oncology, biology, physics, Vol.109(2), pp.515-526
02/01/2021
DOI: 10.1016/j.ijrobp.2020.08.060
PMID: 32898610
Abstract
Purpose: To determine the preirradiation baseline association of white matter integrity with neurocognitive function and to assess posttreatment changes in pediatric patients with craniopharyngioma treated with proton therapy.
Methods and Materials: Ninety children and adolescents (2-20 years old) with craniopharyngioma were treated with proton therapy (54 Gy[RBE]) in a prospective therapeutic trial. Neurocognitive performance at the postoperative baseline before proton therapy and diffusion tensor imaging (DTI) data acquired at baseline and at annual follow-up were analyzed. Tract-based spatial statistics and structural connectomics were used to derive global and local white matter features from DTI. Baseline DTI features were compared for patients with average and below-average neurocognitive performance. Longitudinal DTI data were analyzed to determine the proton dose effect on white matter structures in relation to the irradiated brain volume and baseline age.
Results: Before proton therapy, patients with below-average working memory, processing speed, verbal fluency, verbal learning, or fine motor dexterity exhibited more globally degraded white matter structures compared with their counterparts with average performance, as indicated by lower mean fractional anisotropy, decreased global efficiency, or higher modularity. Surgery, obstructive hydrocephalus, and preoperative hypothalamic involvement appeared to be related to this degradation. In local analyses, tract-based spatial statistics revealed left-lateralized associations with verbal and motor functions, which supported surgical approaches to midline tumors via the right hemisphere. The mean fractional anisotropy of the brain and the global efficiency derived from DTI increased over the 5 years after proton therapy. The rate of increase was lower with larger irradiated brain volumes and in older children.
Conclusions: Below-average baseline neurocognitive performance in patients with craniopharyngioma before proton therapy appeared to be related to structural degradation of white matter tracts. Posttherapy longitudinal DTI showed improving trends in global integrity and efficiency measures, particularly in children in whom a smaller brain volume was irradiated. (C) 2020 Elsevier Inc. All rights reserved.
Details
- Title: Subtitle
- Diffusion Tensor Imaging-Based Analysis of Baseline Neurocognitive Function and Posttreatment White Matter Changes in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Therapy
- Creators
- Jinsoo Uh - St. Jude Children's Research HospitalThomas E. Merchant - St. Jude Children's Research HospitalHeather M. Conklin - St. Jude Children's Research HospitalYousef Ismael - St. Jude Children's Research HospitalYimei Li - St Jude Childrens Res Hosp, Dept Biostat, 332 N Lauderdale St, Memphis, TN 38105 USAYuanyuan Han - St. Jude Children's Research HospitalNoah D. Sabin - St. Jude Children's Research HospitalAbbas Babajani-Feremi - University of Tennessee Health Science CenterDaniel J. Indelicato - Department of Radiation Oncology University of Florida Jacksonville FloridaChia-ho Hua - St. Jude Children's Research Hospital
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.109(2), pp.515-526
- Publisher
- Elsevier
- DOI
- 10.1016/j.ijrobp.2020.08.060
- PMID
- 32898610
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Number of pages
- 12
- Grant note
- American Lebanese Syrian Associated Charities; American Lebanese Syrian Associated Charities (ALSAC)
- Language
- English
- Date published
- 02/01/2021
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984312985402771
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