Publication: Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review
Issued Date
2021-01-01
Resource Type
ISSN
1879355X
03603016
03603016
Other identifier(s)
2-s2.0-85108623900
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Radiation Oncology Biology Physics. (2021)
Suggested Citation
Anita Mahajan, Peter L. Stavinoha, Warissara Rongthong, N. Patrik Brodin, Susan L. McGovern, Issam El Naqa, Joshua D. Palmer, Sabina Vennarini, Daniel J. Indelicato, Paul Aridgides, Daniel C. Bowers, Leontien Kremer, Cecile Ronckers, Louis Constine, Michele Avanzo Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. International Journal of Radiation Oncology Biology Physics. (2021). doi:10.1016/j.ijrobp.2020.11.073 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/76367
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Title
Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review
Other Contributor(s)
Medizinische Hochschule Brandenburg Theodor Fontane
Siriraj Hospital
IRCCS Centro Di Riferimento Oncologico Aviano
University of Rochester Medical Center
SUNY Upstate Medical University
University of Texas MD Anderson Cancer Center
UT Southwestern Medical School
University of Florida
Michigan Medicine
Mayo Clinic
Albert Einstein College of Medicine of Yeshiva University
The Ohio State University Comprehensive Cancer Center
Amsterdam UMC - University of Amsterdam
Princess Máxima Centre for Paediatric Oncology
Proton Therapy Unit
Siriraj Hospital
IRCCS Centro Di Riferimento Oncologico Aviano
University of Rochester Medical Center
SUNY Upstate Medical University
University of Texas MD Anderson Cancer Center
UT Southwestern Medical School
University of Florida
Michigan Medicine
Mayo Clinic
Albert Einstein College of Medicine of Yeshiva University
The Ohio State University Comprehensive Cancer Center
Amsterdam UMC - University of Amsterdam
Princess Máxima Centre for Paediatric Oncology
Proton Therapy Unit
Abstract
Purpose: A PENTEC review of childhood cancer survivors who received brain radiation therapy (RT) was performed to develop models that aid in developing dose constraints for RT-associated central nervous system (CNS) morbidities. Methods and Materials: A comprehensive literature search, through the PENTEC initiative, was performed to identify published data pertaining to 6 specific CNS toxicities in children treated with brain RT. Treatment and outcome data on survivors were extracted and used to generate normal tissue complication probability (NTCP) models. Results: The search identified investigations pertaining to 2 of the 6 predefined CNS outcomes: neurocognition and brain necrosis. For neurocognition, models for 2 post-RT outcomes were developed to (1) calculate the risk for a below-average intelligence quotient (IQ) (IQ <85) and (2) estimate the expected IQ value. The models suggest that there is a 5% risk of a subsequent IQ <85 when 10%, 20%, 50%, or 100% of the brain is irradiated to 35.7, 29.1, 22.2, or 18.1 Gy, respectively (all at 2 Gy/fraction and without methotrexate). Methotrexate (MTX) increased the risk for an IQ <85 similar to a generalized uniform brain dose of 5.9 Gy. The model for predicting expected IQ also includes the effect of dose, age, and MTX. Each of these factors has an independent, but probably cumulative effect on IQ. The necrosis model estimates a 5% risk of necrosis for children after 58.9 Gy or 59.9 Gy (2 Gy/fraction) to any part of the brain if delivered as primary RT or reirradiation, respectively. Conclusions: This PENTEC comprehensive review establishes objective relationships between patient age, RT dose, RT volume, and MTX to subsequent risks of neurocognitive injury and necrosis. A lack of consistent RT data and outcome reporting in the published literature hindered investigation of the other predefined CNS morbidity endpoints.