Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma.

Research output: Contribution to journalArticle

Standard

Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma. / Blomstrand, Malin; Brodin, N Patrik; Munck af Rosenschöld, Per; Vogelius, Ivan R; Sánchez Merino, Gaspar; Kiil-Berthlesen, Anne; Blomgren, Klas; Lannering, Birgitta; Bentzen, Søren M; Björk, Thomas.

In: Neuro-Oncology, Vol. 14, No. 7, 2012, p. 882-889.

Research output: Contribution to journalArticle

Harvard

Blomstrand, M, Brodin, NP, Munck af Rosenschöld, P, Vogelius, IR, Sánchez Merino, G, Kiil-Berthlesen, A, Blomgren, K, Lannering, B, Bentzen, SM & Björk, T 2012, 'Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma.', Neuro-Oncology, vol. 14, no. 7, pp. 882-889. https://doi.org/10.1093/neuonc/nos120

APA

Blomstrand, M., Brodin, N. P., Munck af Rosenschöld, P., Vogelius, I. R., Sánchez Merino, G., Kiil-Berthlesen, A., ... Björk, T. (2012). Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma. Neuro-Oncology, 14(7), 882-889. https://doi.org/10.1093/neuonc/nos120

CBE

Blomstrand M, Brodin NP, Munck af Rosenschöld P, Vogelius IR, Sánchez Merino G, Kiil-Berthlesen A, Blomgren K, Lannering B, Bentzen SM, Björk T. 2012. Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma. Neuro-Oncology. 14(7):882-889. https://doi.org/10.1093/neuonc/nos120

MLA

Vancouver

Blomstrand M, Brodin NP, Munck af Rosenschöld P, Vogelius IR, Sánchez Merino G, Kiil-Berthlesen A et al. Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma. Neuro-Oncology. 2012;14(7):882-889. https://doi.org/10.1093/neuonc/nos120

Author

Blomstrand, Malin ; Brodin, N Patrik ; Munck af Rosenschöld, Per ; Vogelius, Ivan R ; Sánchez Merino, Gaspar ; Kiil-Berthlesen, Anne ; Blomgren, Klas ; Lannering, Birgitta ; Bentzen, Søren M ; Björk, Thomas. / Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma. In: Neuro-Oncology. 2012 ; Vol. 14, No. 7. pp. 882-889.

RIS

TY - JOUR

T1 - Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma.

AU - Blomstrand, Malin

AU - Brodin, N Patrik

AU - Munck af Rosenschöld, Per

AU - Vogelius, Ivan R

AU - Sánchez Merino, Gaspar

AU - Kiil-Berthlesen, Anne

AU - Blomgren, Klas

AU - Lannering, Birgitta

AU - Bentzen, Søren M

AU - Björk, Thomas

PY - 2012

Y1 - 2012

N2 - We sought to assess the feasibility and estimate the benefit of sparing the neurogenic niches when irradiating the brain of pediatric patients with medulloblastoma (MB) based on clinical outcome data. Pediatric MB survivors experience a high risk of neurocognitive adverse effects, often attributed to the whole-brain irradiation that is part of standard management. Neurogenesis is very sensitive to radiation, and limiting the radiation dose to the hippocampus and the subventricular zone (SVZ) may preserve neurocognitive function. Radiotherapy plans were created using 4 techniques: standard opposing fields, intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (IMAT), and intensity-modulated proton therapy (IMPT). Mean dose to the hippocampus and SVZ (mean for both sites) could be limited to 88.3% (range, 83.6%-91.0%), 77.1% (range, 71.5%-81.3%), and 42.3% (range, 26.6%-51.2%) with IMAT, IMRT, and IMPT, respectively, while maintaining at least 95% of the prescribed dose in 95% of the whole-brain target volume. Estimated risks for developing memory impairment after a prescribed dose of 23.4 Gy were 47% (95% confidence interval [CI], 21%-69%), 44% (95% CI, 21%-65%), 41% (95% CI, 22%-60%), and 33% (95% CI, 23%-44%) with opposing fields, IMAT, IMRT, and IMPT, respectively. Neurogenic niche sparing during cranial irradiation of pediatric patients with MB is feasible and is estimated to lower the risks of long-term neurocognitive sequelae. Greatest sparing is achieved with intensity-modulated proton therapy, thus making this an attractive option to be tested in a prospective clinical trial.

AB - We sought to assess the feasibility and estimate the benefit of sparing the neurogenic niches when irradiating the brain of pediatric patients with medulloblastoma (MB) based on clinical outcome data. Pediatric MB survivors experience a high risk of neurocognitive adverse effects, often attributed to the whole-brain irradiation that is part of standard management. Neurogenesis is very sensitive to radiation, and limiting the radiation dose to the hippocampus and the subventricular zone (SVZ) may preserve neurocognitive function. Radiotherapy plans were created using 4 techniques: standard opposing fields, intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (IMAT), and intensity-modulated proton therapy (IMPT). Mean dose to the hippocampus and SVZ (mean for both sites) could be limited to 88.3% (range, 83.6%-91.0%), 77.1% (range, 71.5%-81.3%), and 42.3% (range, 26.6%-51.2%) with IMAT, IMRT, and IMPT, respectively, while maintaining at least 95% of the prescribed dose in 95% of the whole-brain target volume. Estimated risks for developing memory impairment after a prescribed dose of 23.4 Gy were 47% (95% confidence interval [CI], 21%-69%), 44% (95% CI, 21%-65%), 41% (95% CI, 22%-60%), and 33% (95% CI, 23%-44%) with opposing fields, IMAT, IMRT, and IMPT, respectively. Neurogenic niche sparing during cranial irradiation of pediatric patients with MB is feasible and is estimated to lower the risks of long-term neurocognitive sequelae. Greatest sparing is achieved with intensity-modulated proton therapy, thus making this an attractive option to be tested in a prospective clinical trial.

U2 - 10.1093/neuonc/nos120

DO - 10.1093/neuonc/nos120

M3 - Article

VL - 14

SP - 882

EP - 889

JO - Neuro-Oncology

JF - Neuro-Oncology

SN - 1523-5866

IS - 7

ER -