International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 3, Supplement , Pages S20-S27 , 1 March 2010

Radiation Dose–Volume Effects in the Brain

  • Yaacov Richard Lawrence, M.R.C.P.

      Affiliations

    • Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
    • Corresponding Author InformationReprint requests to: Yaacov Richard Lawrence, M.R.C.P., Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Bodine Cancer Center, 111 S. 11th St., Philadelphia, PA 19107. Tel: (215) 955-6700; Fax: (215) 955-0412
  • ,
  • X. Allen Li, Ph.D.

      Affiliations

    • Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
  • ,
  • Issam el Naqa, Ph.D.

      Affiliations

    • Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
  • ,
  • Carol A. Hahn, M.D.

      Affiliations

    • Department of Radiation Oncology, Duke University Medical Center, Durham, NC
  • ,
  • Lawrence B. Marks, M.D.

      Affiliations

    • Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
  • ,
  • Thomas E. Merchant, D.O. Ph.D.

      Affiliations

    • Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
  • ,
  • Adam P. Dicker, M.D. Ph.D.

      Affiliations

    • Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA

Received 26 November 2008 ,Revised 24 February 2009 ,Accepted 27 February 2009.

References 

  1. Lax I, Karlsson B. Prediction of complications in gamma knife radiosurgery of arteriovenous malformation. Acta Oncol. 1996;35:49–55
  2. Voges J, Treuer H, Sturm V, et al. Risk analysis of linear accelerator radiosurgery. Int J Radiat Oncol Biol Phys. 1996;36:1055–1063
  3. Flickinger JC, Kondziolka D, Pollock BE, et al. Complications from arteriovenous malformation radiosurgery: Multivariate analysis and risk modeling. Int J Radiat Oncol Biol Phys. 1997;38:485–490
  4. Miyawaki L, Dowd C, Wara W, et al. Five year results of LINAC radiosurgery for arteriovenous malformations: Outcome for large AVMS. Int J Radiat Oncol Biol Phys. 1999;44:1089–1106
  5. Chin LS, Ma L, DiBiase S. Radiation necrosis following gamma knife surgery: A case-controlled comparison of treatment parameters and long-term clinical follow up. J Neurosurg. 2001;94:899–904
  6. Nakamura JL, Verhey LJ, Smith V, et al. Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys. 2001;51:1313–1319
  7. Barker FG, Butler WE, Lyons S, et al. Dose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations. J Neurosurg. 2003;99:254–263
  8. Friedman WA, Bova FJ, Bollampally S, et al. Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery. 2003;52:296–307
  9. Varlotto JM, Flickinger JC, Niranjan A, et al. Analysis of tumor control and toxicity in patients who have survived at least one year after radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys. 2003;57:452–464
  10. Korytko T, Radivoyevitch T, Colussi V, et al. 12 Gy gamma knife radiosurgical volume is a predictor for radiation necrosis in non-AVM intracranial tumors. Int J Radiat Oncol Biol Phys. 2006;64:419–424
  11. Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: Final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys. 2000;47:291–298
  12. Lee AW, Kwong DL, Leung SF, et al. Factors affecting risk of symptomatic temporal lobe necrosis: Significance of fractional dose and treatment time. Int J Radiat Oncol Biol Phys. 2002;53:75–85
  13. Lee AW, Foo W, Chappell R, et al. Effect of time, dose, and fractionation on temporal lobe necrosis following radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 1998;40:35–42
  14. Corn BW, Yousem DM, Scott CB, et al. White matter changes are correlated significantly with radiation dose: Observations from a randomized dose-escalation trial for malignant glioma (Radiation Therapy Oncology Group 83-02). Cancer. 1994;74:2828–2835
  15. Ruben JD, Dally M, Bailey M, et al. Cerebral radiation necrosis: Incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys. 2006;65:499–508
  16. Shaw E, Arusell R, Scheithauer B, et al. Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: Initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol. 2002;20:2267–2276
  17. Murray KJ, Scott C, Greenberg HM, et al. A randomized phase III study of accelerated hyperfractionation versus standard in patients with unresected brain metastases: A report of the Radiation Therapy Oncology Group (RTOG) 9104. Int J Radiat Oncol Biol Phys. 1997;39:571–574
  18. Sause WT, Scott C, Krisch R, et al. Phase I/II trial of accelerated fractionation in brain metastases RTOG 85-28. Int J Radiat Oncol Biol Phys. 1993;26:653–657
  19. Jen YM, Hsu WL, Chen CY, et al. Different risks of symptomatic brain necrosis in NPC patients treated with different altered fractionated radiotherapy techniques. Int J Radiat Oncol Biol Phys. 2001;51:344–348
  20. Fowler JF. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989;62:679–694
  21. Smyth MD, Sneed PK, Ciricillo SF, et al. Stereotactic radiosurgery for pediatric intracranial arteriovenous malformations: The University of California at San Francisco experience. J Neurosurg. 2002;97:48–55
  22. Tanaka T, Kobayashi T, Kida Y, et al. Comparison between adult and pediatric arteriovenous malformations treated by gamma knife radiosurgery. Stereotact Funct Neurosurg. 1996;66(Suppl. 1):288–295
  23. Hill JM, Kornblith AB, Jones D, et al. A comparative study of the long term psychosocial functioning of childhood acute lymphoblastic leukemia survivors treated by intrathecal methotrexate with or without cranial radiation. Cancer. 1998;82:208–218
  24. Waber DP, Turek J, Catania L, et al. Neuropsychological outcomes from a randomized trial of triple intrathecal chemotherapy compared with 18 Gy cranial radiation as CNS treatment in acute lymphoblastic leukemia: Findings from Dana-Farber Cancer Institute ALL Consortium Protocol 95-01. J Clin Oncol. 2007;25:4914–4921
  25. Moore IM, Kramer JH, Wara W, et al. Cognitive function in children with leukemia. Effect of radiation dose and time since irradiation. Cancer. 1991;68:1913–1917
  26. Smibert E, Anderson V, Godber T, et al. Risk factors for intellectual and educational sequelae of cranial irradiation in childhood acute lymphoblastic leukaemia. Br J Cancer. 1996;73:825–830
  27. Mulhern RK, Kepner JL, Thomas PR, et al. Neuropsychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose craniospinal irradiation: A Pediatric Oncology Group study. J Clin Oncol. 1998;16:1723–1728
  28. Mulhern RK, Fairclough D, Ochs J. A prospective comparison of neuropsychologic performance of children surviving leukemia who received 18-Gy, 24-Gy, or no cranial irradiation. J Clin Oncol. 1991;9:1348–1356
  29. Jannoun L, Bloom HJ. Long-term psychological effects in children treated for intracranial tumors. Int J Radiat Oncol Biol Phys. 1990;18:747–753
  30. Smith MC, Ryken TC, Buatti JM. Radiotoxicity after conformal radiation therapy for benign intracranial tumors. Neurosurg Clin North Am. 2006;17:169–180vii
  31. Bleyer WA, Fallavollita J, Robison L, et al. Influence of age, sex, and concurrent intrathecal methotrexate therapy on intellectual function after cranial irradiation during childhood: A report from the Children's Cancer Study Group. Pediatr Hematol Oncol. 1990;7:329–338
  32. Merchant TE, Kiehna EN, Li C, et al. Modeling radiation dosimetry to predict cognitive outcomes in pediatric patients with CNS embryonal tumors including medulloblastoma. Int J Radiat Oncol Biol Phys. 2006;65:210–221
  33. DeAngelis LM, Delattre JY, Posner JB. Radiation-induced dementia in patients cured of brain metastases. Neurology. 1989;39:789–796
  34. Gregor A, Cull A, Stephens RJ, et al. United Kingdom Coordinating Committee for Cancer Research (UKCCCR) and the European Organization for Research and Treatment of Cancer (EORTC) Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: Results of a multicentre randomised trial. Eur J Cancer. 1997;33:1752–1758
  35. Steinvorth S, Wenz F, Wildermuth S, et al. Cognitive function in patients with cerebral arteriovenous malformations after radiosurgery: Prospective long-term follow-up. Int J Radiat Oncol Biol Phys. 2002;54:1430–1437
  36. Steinvorth S, Welzel G, Fuss M, et al. Neuropsychological outcome after fractionated stereotactic radiotherapy (FSRT) for base of skull meningiomas: A prospective 1-year follow-up. Radiother Oncol. 2003;69:177–182
  37. Khuntia D, Brown P, Li J, et al. Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol. 2006;24:1295–1304
  38. Armstrong C, Ruffer J, Corn B, et al. Biphasic patterns of memory deficits following moderate-dose partial-brain irradiation: Neuropsychologic outcome and proposed mechanisms. J Clin Oncol. 1995;13:2263–2271
  39. Li J, Bentzen SM, Renschler M, et al. Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function. J Clin Oncol. 2007;25:1260–1266
  40. Armstrong CL, Hunter JV, Ledakis GE, et al. Late cognitive and radiographic changes related to radiotherapy: Initial prospective findings. Neurology. 2002;59:40–48
  41. Vigliani MC, Sichez N, Poisson M, et al. A prospective study of cognitive functions following conventional radiotherapy for supratentorial gliomas in young adults: 4-Year results. Int J Radiat Oncol Biol Phys. 1996;35:527–533
  42. Grosshans DR, Meyers CA, Allen PK, et al. Neurocognitive function in patients with small cell lung cancer: Effect of prophylactic cranial irradiation. Cancer. 2008;112:589–595
  43. Arriagada R, Le Chevalier T, Borie F, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst. 1995;87:183–190
  44. Klein M, Heimans J, Aaronson N, et al. Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: A comparative study. Lancet. 2002;360:1361–1368
  45. Surma-aho O, Niemelä M, Vilkki J, et al. Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology. 2001;56:1285–1290
  46. Kiebert GM, Curran D, Aaronson NK, et al. EORTC Radiotherapy Co-operative Group Quality of life after radiation therapy of cerebral low-grade gliomas of the adult: Results of a randomised phase III trial on dose response (EORTC trial 22844). Eur J Cancer. 1998;34:1902–1909
  47. Brown P. Effects of radiotherapy on cognitive function in patients with low-grade glioma measured by the Folstein Mini-Mental State Examination. J Clin Oncol. 2003;21:2519–2524
  48. Gregor A, Cull A, Traynor E, et al. Neuropsychometric evaluation of long-term survivors of adult brain tumours: Relationship with tumour and treatment parameters. Radiother Oncol. 1996;41:55–59
  49. Kleinberg L, Wallner K, Malkin MG. Good performance status of long-term disease-free survivors of intracranial gliomas. Int J Radiat Oncol Biol Phys. 1993;26:129–133
  50. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: A randomized controlled trial. JAMA. 2006;295:2483–2491
  51. Flickinger JC, Kondziolka D, Maitz AH, et al. Analysis of neurological sequelae from radiosurgery of arteriovenous malformations: How location affects outcome. Int J Radiat Oncol Biol Phys. 1998;40:273–278
  52. Merchant TE, Conklin HM, Wu S, et al. Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: Prospective evaluation of cognitive, endocrine and hearing deficits. J Clin Oncol. 2009;27:3691–3697
  53. Brown RT, Madan-Swain A, Walco GA, et al. Cognitive and academic late effects among children previously treated for acute lymphocytic leukemia receiving chemotherapy as CNS prophylaxis. J Pediatr Psychol. 1998;23:333–340
  54. Meadows AT, Gordon J, Massari DJ, et al. Declines in IQ scores and cognitive dysfunctions in children with acute lymphocytic leukaemia treated with cranial irradiation. Lancet. 1981;2:1015–1018
  55. Ellenberg L, McComb JG, Siegel SE, et al. Factors affecting intellectual outcome in pediatric brain tumor patients. Neurosurgery. 1987;21:638–644
  56. Merchant TE, Lee H, Zhu J, et al. The effects of hydrocephalus on intelligence quotient in children with localized infratentorial ependymoma before and after focal radiation therapy. J Neurosurg. 2004;101:159–168
  57. Hirsch JF, Renier D, Czernichow P, et al. Medulloblastoma in childhood: Survival and functional results. Acta Neurochir (Wien). 1979;48:1–15
  58. Duffner PK. Long-term effects of radiation therapy on cognitive and endocrine function in children with leukemia and brain tumors. Neurologist. 2004;10:293–310
  59. Mayer R, Sminia P. Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys. 2008;70:1350–1360
  60. Omuro AMP, Ben-Porat LS, Panageas KS, et al. Delayed neurotoxicity in primary central nervous system lymphoma. Arch Neurol. 2005;62:1595–1600
  61. Schlegel U, Pels H, Oehring R, et al. Neurologic sequelae of treatment of primary CNS lymphomas. J Neurooncol. 1999;43:277–286
  62. Shah GD, Yahalom J, Correa DD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol. 2007;25:4730–4735
  63. Chan YL, Yeung DK, Leung SF, et al. Dynamic susceptibility contrast-enhanced perfusion MR imaging in late radiation-induced injury of the brain. Acta Neurochir Suppl. 2005;95:173–175
  64. Price SJ, Jena R, Green HA, et al. Early radiotherapy dose response and lack of hypersensitivity effect in normal brain tissue: A sequential dynamic susceptibility imaging study of cerebral perfusion. Clin Oncol (R Coll Radiol). 2007;19:577–587
  65. Fuss M, Wenz F, Scholdei R, et al. Radiation-induced regional cerebral blood volume (rCBV) changes in normal brain and low-grade astrocytomas: quantification and time and dose-dependent occurrence. Int J Radiat Oncol Biol Phys. 2000;48:53–58
  66. Hahn C, Zhou S, Raynor R, et al. Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism, and neurocognitive dysfunction. Int J Radiat Oncol Biol Phys. 2009;73:1082–1087
  67. Maruyama K, Kamada K, Ota T, et al. Tolerance of pyramidal tract to gamma knife radiosurgery based on diffusion-tensor tractography. Int J Radiat Oncol Biol Phys. 2008;70:1330–1335

 Y. R. Lawrence is supported by The ASCO Cancer Foundation Young Investigator Award. Any opinions, findings, and conclusions expressed in this material are those of the author(s) and do not necessarily reflect those of the American Society of Clinical Oncology or The ASCO Cancer Foundation. L. B. Marks is supported by NIH R01 69579 and the Lance Armstrong Foundation.

 A. P. Dicker is supported by National Institutes of Health Grant CA10663, Tobacco Research Settlement Fund (State of Pennsylvania), and the Christine Baxter Fund.

 Conflict of interest: none.

PII: S0360-3016(09)03287-8

doi: 10.1016/j.ijrobp.2009.02.091

International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 3, Supplement , Pages S20-S27 , 1 March 2010