TY - JOUR
T1 - Spectrum of neuroimaging findings post-proton beam therapy in a large pediatric cohort
AU - Bhattacharya, Debarata
AU - Chhabda, Sahil
AU - Lakshmanan, Rahul
AU - Tan, Ronald
AU - Warne, Richard
AU - Benenati, Massimo
AU - Michalski, Anthony
AU - Aquilina, Kristian
AU - Jacques, Thomas
AU - Hargrave, Darren
AU - Chang, Yen Ching
AU - Gains, Jenny
AU - Mankad, Kshitij
PY - 2021/2
Y1 - 2021/2
N2 - Purpose: Proton beam therapy (PBT) is now well established for the treatment of certain pediatric brain tumors. The intrinsic properties of PBT are known to reduce long-term negative effects of photon radiotherapy (PRT). To better understand the intracranial effects of PBT, we analyzed the longitudinal imaging changes in a cohort of children with brain tumors treated by PBT with clinical and radiotherapy dose correlations. Materials and methods: Retrospective imaging review of 46 patients from our hospital with brain tumors treated by PBT. The imaging findings were correlated with clinical and dose parameters. Results: Imaging changes were assessed by reviewing serial magnetic resonance imaging (MRI) scans following PBT over a follow-up period ranging from 1 month to 7 years. Imaging changes were observed in 23 patients undergoing PBT and categorized as pseudoprogression (10 patients, 43%), white matter changes (6 patients, 23%), parenchymal atrophy (6 patients, 23%), and cerebral large vessel arteriopathy (5 patients, 25%). Three patients had more than one type of imaging change. Clinical symptoms attributable to PBT were observed in 13 (28%) patients. Conclusion: In accordance with published literature, we found evidence of varied intracranial imaging changes in pediatric brain tumor patients treated with PBT. There was a higher incidence (10%) of large vessel cerebral arteriopathy in our cohort than previously described in the literature. Twenty-eight percent of patients had clinical sequelae as a result of these changes, particularly in the large vessel arteriopathy subgroup, arguing the need for angiographic and perfusion surveillance to pre-empt any morbidities and offer potential neuro-protection.
AB - Purpose: Proton beam therapy (PBT) is now well established for the treatment of certain pediatric brain tumors. The intrinsic properties of PBT are known to reduce long-term negative effects of photon radiotherapy (PRT). To better understand the intracranial effects of PBT, we analyzed the longitudinal imaging changes in a cohort of children with brain tumors treated by PBT with clinical and radiotherapy dose correlations. Materials and methods: Retrospective imaging review of 46 patients from our hospital with brain tumors treated by PBT. The imaging findings were correlated with clinical and dose parameters. Results: Imaging changes were assessed by reviewing serial magnetic resonance imaging (MRI) scans following PBT over a follow-up period ranging from 1 month to 7 years. Imaging changes were observed in 23 patients undergoing PBT and categorized as pseudoprogression (10 patients, 43%), white matter changes (6 patients, 23%), parenchymal atrophy (6 patients, 23%), and cerebral large vessel arteriopathy (5 patients, 25%). Three patients had more than one type of imaging change. Clinical symptoms attributable to PBT were observed in 13 (28%) patients. Conclusion: In accordance with published literature, we found evidence of varied intracranial imaging changes in pediatric brain tumor patients treated with PBT. There was a higher incidence (10%) of large vessel cerebral arteriopathy in our cohort than previously described in the literature. Twenty-eight percent of patients had clinical sequelae as a result of these changes, particularly in the large vessel arteriopathy subgroup, arguing the need for angiographic and perfusion surveillance to pre-empt any morbidities and offer potential neuro-protection.
KW - Brain tumor
KW - Large vessel arteriopathy
KW - Pediatric
KW - Photon radiotherapy
KW - Proton beam therapy
KW - Pseudoprogression
KW - Radiation necrosis
UR - http://www.scopus.com/inward/record.url?scp=85088514105&partnerID=8YFLogxK
U2 - 10.1007/s00381-020-04819-9
DO - 10.1007/s00381-020-04819-9
M3 - Article
C2 - 32705327
AN - SCOPUS:85088514105
SN - 1433-0350
VL - 37
SP - 435
EP - 446
JO - Child's Nervous System
JF - Child's Nervous System
IS - 2
ER -