Dose-Dependent Effects of Radiation Therapy on Cerebral Blood Flow, Metabolism, and Neurocognitive Dysfunction
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)
- Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC (United States)
- 21st Century Oncology/Southern New England Regional Cancer Center, Woonsocket, RI (United Kingdom)
- Department of Radiology, Duke University Medical Center, Durham, NC (United States)
- Duke Cancer Center Biostatistics, Duke University Medical Center, Durham, NC (United States)
Purpose: A prospective study was performed to formally relate dose-dependent radiologically defined changes in normal brain induced by radiotherapy (RT) to neurocognitive dysfunction in subjects with primary brain tumors. Methods and Materials: Adult patients receiving three-dimensional RT for central nervous system (CNS) tumors were enrolled. Positron emission tomography (PET) scanning and neuropsychological testing were performed before RT and 3 weeks and 6 months after treatment. Analyses were performed for correlations between changes in 2-deoxy-2-[{sup 18}F]-fluoro-D-glucose (FDG)-PET (metabolism), {sup 15}O-PET (relative blood flow), regional radiation dose, follow-up time, and neuropsychological test scores. Results: Eleven subjects were enrolled and 6 completed follow-up studies. The PET data showed reduced FDG uptake, with average decreases of 2-6% in regions of the brain receiving greater than 40 Gy at 3 weeks' and 6 months' follow-up. The {sup 15}O-H{sub 2}O PET showed increases (<10%) at 3 weeks in relative regional blood flow in brain receiving greater than 30 Gy, but less at the 6-month follow-up studies. There were significant correlations between decreases in FDG uptake and increased scores from the Symptom Checklist-90-R, with an average increase in T score of 2 (p < 0.0001). The Wisconsin Card Sorting Test showed a significant correlation of decreased FDG uptake with increased errors and perseveration in test performance, with an average decrease in T score of 11 (p = 0.037). Conclusions: A dose-dependent response of CNS tissue was detected using FDG PET in this small number of patients. Decreases in CNS metabolism correlated with decreased performance on neuropsychological tests for problem solving, cognitive flexibility, and global measures of psychopathology. Additional research is needed to verify and define these findings.
- OSTI ID:
- 21172668
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 73, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2008.05.061; PII: S0360-3016(08)02456-5; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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