Subtle white matter volume differences in children treated for medulloblastoma with conventional or reduced dose craniospinal irradiation

Wilburn E. Reddickaij, J. Matthew Russell, John O. Glass, Xiaoping Xiong, Raymond K. Mulhern, James W. Langston, Thomas E. Merchant, Larry E. Kun, Amar Gajjar

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Medulloblastoma is the most common malignant brain tumor in children, and approximately seventy percent of average-risk patients will achieve long-term survival. Craniospinal irradiation (CSI), combined with chemotherapy and surgery, is currently the mainstay of treatment but places children who survive at risk for serious neurocognitive sequelae. These sequelae are intensified with a younger age at treatment, greater elapsed time following treatment, and an increased radiation dose. Many newer treatment approaches have attempted to address this problem by reducing the dose of the CSI component of radiation therapy while maintaining the current survival rates. This study evaluates longitudinal MR imaging during therapy to assess the impact of the two CSI doses (conventional [36 Gy] and reduced [23.4 Gy]) on normal appearing white matter volumes (NAWMV) evaluated in a single index slice. Twenty-six children and young adults at least three years of age enrolled on an institutional protocol for newly diagnosed, previously untreated primary medulloblastoma had at least four MR examinations over a minimum nine month period following CSI. These serial volumes were evaluated as a function of time since CSI in three analyses: 1) all subjects, 2) subjects stratified by age at CSI, and 3) subjects stratified by CSI dose. The first analysis demonstrated that medulloblastoma patients treated with CSI have a significant loss of NAWMV in contradistiction to normally expected maturation. Stratifying the patients by age at CSI found no significant differences in the rate of NAWMV loss. The final analysis stratified the patients by CSI dose and revealed that the rate of NAWMV loss was 23% slower in children receiving reduced-dose. Serial quantitative MR measures of NAWMV may provide a neuroanatomical substrate for assessing functional impact of CSI on normal brain function following treatment for medulloblastoma. (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)787-793
Number of pages7
JournalMagnetic Resonance Imaging
Volume18
Issue number7
DOIs
StatePublished - Oct 24 2000

Fingerprint

Craniospinal Irradiation
Medulloblastoma
Dosimetry
Irradiation
Brain
White Matter
Therapeutics
Chemotherapy
Radiotherapy
Brain Neoplasms
Surgery
Longitudinal Studies
Tumors
Young Adult

Keywords

  • Image processing
  • Image segmentation
  • Radiation therapy
  • White matter

ASJC Scopus subject areas

  • Biophysics
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging

Cite this

Subtle white matter volume differences in children treated for medulloblastoma with conventional or reduced dose craniospinal irradiation. / Reddickaij, Wilburn E.; Russell, J. Matthew; Glass, John O.; Xiong, Xiaoping; Mulhern, Raymond K.; Langston, James W.; Merchant, Thomas E.; Kun, Larry E.; Gajjar, Amar.

In: Magnetic Resonance Imaging, Vol. 18, No. 7, 24.10.2000, p. 787-793.

Research output: Contribution to journalArticle

Reddickaij, WE, Russell, JM, Glass, JO, Xiong, X, Mulhern, RK, Langston, JW, Merchant, TE, Kun, LE & Gajjar, A 2000, 'Subtle white matter volume differences in children treated for medulloblastoma with conventional or reduced dose craniospinal irradiation', Magnetic Resonance Imaging, vol. 18, no. 7, pp. 787-793. https://doi.org/10.1016/S0730-725X(00)00182-X
Reddickaij, Wilburn E. ; Russell, J. Matthew ; Glass, John O. ; Xiong, Xiaoping ; Mulhern, Raymond K. ; Langston, James W. ; Merchant, Thomas E. ; Kun, Larry E. ; Gajjar, Amar. / Subtle white matter volume differences in children treated for medulloblastoma with conventional or reduced dose craniospinal irradiation. In: Magnetic Resonance Imaging. 2000 ; Vol. 18, No. 7. pp. 787-793.
@article{15874e346539423f95b34ca9387a4cec,
title = "Subtle white matter volume differences in children treated for medulloblastoma with conventional or reduced dose craniospinal irradiation",
abstract = "Medulloblastoma is the most common malignant brain tumor in children, and approximately seventy percent of average-risk patients will achieve long-term survival. Craniospinal irradiation (CSI), combined with chemotherapy and surgery, is currently the mainstay of treatment but places children who survive at risk for serious neurocognitive sequelae. These sequelae are intensified with a younger age at treatment, greater elapsed time following treatment, and an increased radiation dose. Many newer treatment approaches have attempted to address this problem by reducing the dose of the CSI component of radiation therapy while maintaining the current survival rates. This study evaluates longitudinal MR imaging during therapy to assess the impact of the two CSI doses (conventional [36 Gy] and reduced [23.4 Gy]) on normal appearing white matter volumes (NAWMV) evaluated in a single index slice. Twenty-six children and young adults at least three years of age enrolled on an institutional protocol for newly diagnosed, previously untreated primary medulloblastoma had at least four MR examinations over a minimum nine month period following CSI. These serial volumes were evaluated as a function of time since CSI in three analyses: 1) all subjects, 2) subjects stratified by age at CSI, and 3) subjects stratified by CSI dose. The first analysis demonstrated that medulloblastoma patients treated with CSI have a significant loss of NAWMV in contradistiction to normally expected maturation. Stratifying the patients by age at CSI found no significant differences in the rate of NAWMV loss. The final analysis stratified the patients by CSI dose and revealed that the rate of NAWMV loss was 23{\%} slower in children receiving reduced-dose. Serial quantitative MR measures of NAWMV may provide a neuroanatomical substrate for assessing functional impact of CSI on normal brain function following treatment for medulloblastoma. (C) 2000 Elsevier Science Inc.",
keywords = "Image processing, Image segmentation, Radiation therapy, White matter",
author = "Reddickaij, {Wilburn E.} and Russell, {J. Matthew} and Glass, {John O.} and Xiaoping Xiong and Mulhern, {Raymond K.} and Langston, {James W.} and Merchant, {Thomas E.} and Kun, {Larry E.} and Amar Gajjar",
year = "2000",
month = "10",
day = "24",
doi = "10.1016/S0730-725X(00)00182-X",
language = "English (US)",
volume = "18",
pages = "787--793",
journal = "Magnetic Resonance Imaging",
issn = "0730-725X",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - Subtle white matter volume differences in children treated for medulloblastoma with conventional or reduced dose craniospinal irradiation

AU - Reddickaij, Wilburn E.

AU - Russell, J. Matthew

AU - Glass, John O.

AU - Xiong, Xiaoping

AU - Mulhern, Raymond K.

AU - Langston, James W.

AU - Merchant, Thomas E.

AU - Kun, Larry E.

AU - Gajjar, Amar

PY - 2000/10/24

Y1 - 2000/10/24

N2 - Medulloblastoma is the most common malignant brain tumor in children, and approximately seventy percent of average-risk patients will achieve long-term survival. Craniospinal irradiation (CSI), combined with chemotherapy and surgery, is currently the mainstay of treatment but places children who survive at risk for serious neurocognitive sequelae. These sequelae are intensified with a younger age at treatment, greater elapsed time following treatment, and an increased radiation dose. Many newer treatment approaches have attempted to address this problem by reducing the dose of the CSI component of radiation therapy while maintaining the current survival rates. This study evaluates longitudinal MR imaging during therapy to assess the impact of the two CSI doses (conventional [36 Gy] and reduced [23.4 Gy]) on normal appearing white matter volumes (NAWMV) evaluated in a single index slice. Twenty-six children and young adults at least three years of age enrolled on an institutional protocol for newly diagnosed, previously untreated primary medulloblastoma had at least four MR examinations over a minimum nine month period following CSI. These serial volumes were evaluated as a function of time since CSI in three analyses: 1) all subjects, 2) subjects stratified by age at CSI, and 3) subjects stratified by CSI dose. The first analysis demonstrated that medulloblastoma patients treated with CSI have a significant loss of NAWMV in contradistiction to normally expected maturation. Stratifying the patients by age at CSI found no significant differences in the rate of NAWMV loss. The final analysis stratified the patients by CSI dose and revealed that the rate of NAWMV loss was 23% slower in children receiving reduced-dose. Serial quantitative MR measures of NAWMV may provide a neuroanatomical substrate for assessing functional impact of CSI on normal brain function following treatment for medulloblastoma. (C) 2000 Elsevier Science Inc.

AB - Medulloblastoma is the most common malignant brain tumor in children, and approximately seventy percent of average-risk patients will achieve long-term survival. Craniospinal irradiation (CSI), combined with chemotherapy and surgery, is currently the mainstay of treatment but places children who survive at risk for serious neurocognitive sequelae. These sequelae are intensified with a younger age at treatment, greater elapsed time following treatment, and an increased radiation dose. Many newer treatment approaches have attempted to address this problem by reducing the dose of the CSI component of radiation therapy while maintaining the current survival rates. This study evaluates longitudinal MR imaging during therapy to assess the impact of the two CSI doses (conventional [36 Gy] and reduced [23.4 Gy]) on normal appearing white matter volumes (NAWMV) evaluated in a single index slice. Twenty-six children and young adults at least three years of age enrolled on an institutional protocol for newly diagnosed, previously untreated primary medulloblastoma had at least four MR examinations over a minimum nine month period following CSI. These serial volumes were evaluated as a function of time since CSI in three analyses: 1) all subjects, 2) subjects stratified by age at CSI, and 3) subjects stratified by CSI dose. The first analysis demonstrated that medulloblastoma patients treated with CSI have a significant loss of NAWMV in contradistiction to normally expected maturation. Stratifying the patients by age at CSI found no significant differences in the rate of NAWMV loss. The final analysis stratified the patients by CSI dose and revealed that the rate of NAWMV loss was 23% slower in children receiving reduced-dose. Serial quantitative MR measures of NAWMV may provide a neuroanatomical substrate for assessing functional impact of CSI on normal brain function following treatment for medulloblastoma. (C) 2000 Elsevier Science Inc.

KW - Image processing

KW - Image segmentation

KW - Radiation therapy

KW - White matter

UR - http://www.scopus.com/inward/record.url?scp=0033772318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033772318&partnerID=8YFLogxK

U2 - 10.1016/S0730-725X(00)00182-X

DO - 10.1016/S0730-725X(00)00182-X

M3 - Article

C2 - 11027871

AN - SCOPUS:0033772318

VL - 18

SP - 787

EP - 793

JO - Magnetic Resonance Imaging

JF - Magnetic Resonance Imaging

SN - 0730-725X

IS - 7

ER -