Clinical relevance of the radiation dose bath in lower grade glioma, a cross-sectional pilot study on neurocognitive and radiological outcome

Hiska L van der Weide; Justyna Kłos; Johannes A Langendijk; Charlotte L Brouwer; Peter F Sinnige; Ronald J H Borra; Rudi A J O Dierckx; Rients B Huitema; Sandra E Rakers; Anne M Buunk; Jacoba M Spikman; Ingeborg B Bosma; Roelien H Enting; Merethe Blandhol; Roland K Chiu; Anouk van der Hoorn; Miranda C A Kramer

doi:10.1016/j.ctro.2022.02.001

Clinical relevance of the radiation dose bath in lower grade glioma, a cross-sectional pilot study on neurocognitive and radiological outcome

Clin Transl Radiat Oncol. 2022 Feb 8:33:99-105. doi: 10.1016/j.ctro.2022.02.001. eCollection 2022 Mar.

Authors

Hiska L van der Weide¹, Justyna Kłos^{2

3}, Johannes A Langendijk¹, Charlotte L Brouwer¹, Peter F Sinnige¹, Ronald J H Borra^{2

3}, Rudi A J O Dierckx^{2

3}, Rients B Huitema⁴, Sandra E Rakers⁴, Anne M Buunk⁴, Jacoba M Spikman⁴, Ingeborg B Bosma⁴, Roelien H Enting⁴, Merethe Blandhol⁵, Roland K Chiu⁵, Anouk van der Hoorn³, Miranda C A Kramer¹

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
² University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
³ University of Groningen, University Medical Center Groningen, Department of Radiology Hanzeplein 1, 9713GZ Groningen, The Netherlands.
⁴ University of Groningen, University Medical Center Groningen, Department of Neurology, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
⁵ University College Groningen, University of Groningen, Hoendiepskade 24, 9718BG Groningen, The Netherlands.

Abstract

Aim: To investigate the clinical relevance of the radiotherapy (RT) dose bath in patients treated for lower grade glioma (LGG).

Methods: Patients (n = 17) treated with RT for LGG were assessed with neurocognitive function (NCF) tests and structural Magnetic Resonance Imaging (MRI) and categorized in subgroups based on tumour lateralisation. RT dose, volumetric results and cerebral microbleed (CMB) number were extracted for contralateral cerebrum, contralateral hippocampus, and cerebellum. The RT clinical target volume (CTV) was included in the analysis as a surrogate for focal tumour and other treatment effects. The relationships between RT dose, CTV, NCF and radiological outcome were analysed per subgroup.

Results: The subgroup with left-sided tumours (n = 10) performed significantly lower on verbal tests. The RT dose to the right cerebrum, as well as CTV, were related to poorer performance on tests for processing speed, attention, and visuospatial abilities, and more CMB.In the subgroup with right-sided tumours (n = 7), RT dose in the left cerebrum was related to lower verbal memory performance, (immediate and delayed recall, r = -0.821, p = 0.023 and r = -0.937, p = 0.002, respectively), and RT dose to the left hippocampus was related to hippocampal volume (r = -0.857, p = 0.014), without correlation between CTV and NCF.

Conclusion: By using a novel approach, we were able to investigate the clinical relevance of the RT dose bath in patients with LGG more specifically. We used combined MRI-derived and NCF outcome measures to assess radiation-induced brain damage, and observed potential RT effects on the left-sided brain resulting in lower verbal memory performance and hippocampus volume.

Keywords: CFT, Rey Complex Figure Test; CMB, Cerebral Microbleed; COWAT, Controlled Oral Word Association Test; CTV, Clinical Target Volume; Cerebral microbleeds; FLAIR, Fluid-Attenuated Inversion Recovery; FoV, Field-of-View; Glioma; IDH, Isocitrate DeHydrogenase; LGG, Lower Grade Glioma; MRI, Magnetic Resonance Imaging; NCF, Neurocognitive Function; NTCP, Normal Tissue Complication Prediction; Neurocognitive function; RAVLT-DR, Rey’s Auditory Verbal Learning Test – delayed recall; RAVLT-IR, Rey’s Auditory Verbal Learning Test – immediate recall; RIBD, Radiation-Induced Brain Damage; RT, Radiotherapy; Radiotherapy; SDMT, Symbol Digit Modalities Test; SWI, Susceptibility-Weighted Imaging; T, Tesla; TE, Echo Time; TI, Inversion Time; TMTA, Trail Making Test part A; TMTB, Trail Making Test part B; TMTBA, Trail Making Test part B divided by A; TR, Repetition Time; UMCG, University Medical Center Groningen; Verbal memory; Volumetry; WHO, World Health Organisation.