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Factors impacting volumetric white matter changes following whole brain radiation therapy

  • Clinical Study – Patient Study
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Abstract

Whole brain radiation therapy (WBRT) is one of the most effective modalities for treatment of brain metastases. With increasing cancer control there is growing concern regarding the long-term effects of treatment. These effects are seen as white matter change (WMC) on brain MRI. Severity of WMC is implicated in cognitive and functional decline in many patient groups. Our objective was to identify clinical factors associated with greater accumulation of WMC following WBRT. Through retrospective review of serial MRIs obtained from 30 patients surviving greater than 1 year after WBRT, treated at a single institution between 2002 and 2007, we calculated volumetric WMC over time using segmentation software. Changes related to tumor, secondary effects, surgery or radiosurgery were excluded. Factors that influenced the rate of WMC accumulation were identified through multivariate analysis. Following WBRT, patients accumulated WMC at an average rate of 0.07% of total brain volume per month. In multivariate analyses, greater rates of accumulation were independently associated with older age (β = 0.004, p < .0001), poor levels of glycemic control (β = 0.048, p < .0001) and hypertension diagnosis (β = 0.084, p < .0001). Long-term survivors of cancer allow assessment of late effects of treatment modalities. Radiation injury appears to be related to a steady rate of white matter damage over time, as indicated by progressive accumulation of WMC. Our results suggest that rate of WMC accumulation is enhanced by parameters such as hyperglycemia and hypertension. This has significant clinical impact by clearly identifying hyperglycemia, steroid-induced hyperglycemia, and other vascular risk factors as targets for intervention to decrease WMC in patients receiving WBRT.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA

    Nicholas Szerlip & William Maggio

  2. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA

    Charles Rutter, Susannah Yovino, Young Kwok & William F. Regine

  3. Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA

    Nilam Ram

Authors
  1. Nicholas Szerlip
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  2. Charles Rutter
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  3. Nilam Ram
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  4. Susannah Yovino
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  5. Young Kwok
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  6. William Maggio
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  7. William F. Regine
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Correspondence to Nicholas Szerlip.

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N. Szerlip and C. Rutter are equal contributors.

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Szerlip, N., Rutter, C., Ram, N. et al. Factors impacting volumetric white matter changes following whole brain radiation therapy. J Neurooncol 103, 111–119 (2011). https://doi.org/10.1007/s11060-010-0358-7

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  • DOI: https://doi.org/10.1007/s11060-010-0358-7

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