A Prospective Pilot Study of Cognitive Changes in Patients Receiving Partial Brain Radiation: Development of a Radiation Dose-toxicity Model for Neuroanatomic Targets
Lead Researcher: Sara J Hardy
Cranial radiation therapy (RT), commonly used to treat benign and malignant brain tumors, can lead to cognitive impairments in domains not related to neuroanatomic structures directly impacted by the tumor. The study will prospectively enroll 58 patients with benign and low-grade brain tumors who will undergo partial brain RT, with either conventionally fractionated or hypofractionated schedules. Subjects will receive MRI scans at baseline and 6 months. Given the role of the limbic system in key cognitive functions affected by RT, researchers have a particular interest in characterizing MRI changes in the limbic system and thalamus in relation to memory and related processes.
To examine objective neurocognitive changes over time. The investigators hypothesize that they will see RT-induced neurocognitive impairment in up to 50% of patients after cranial RT.
To examine changes in brain tissue (via MRI) induced by off-target RT in patients with benign and low-grade brain tumors. The investigators specifically hypothesize that comapping of RT dose and MRI changes in the thalamus and limbic system (i.e., thalamic nuclei, hippocampus, fornix, hypothalamus/mammillary bodies, limbic lobe, cingulum) will be most distorted by off-target RT.
To examine the relationship between MRI changes for key neuroanatomic structures identified in Aim 1 with objective neurocognitive testing. The investigators hypothesize that cognitive decline will be correlated with damage revealed by MRI to limbic and thalamic structures.
This research will help to define which neuroanatomic structures are most at risk from RT-induced damage and will help ultimately establish new dose constraint guidelines for important structures to improve cognitive outcomes.
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Milano MT, Bates JE, Budnik J, Qiu H, Hardy S, Cummings MA, Baumgart MA, Maggiore RJ, Mulford DA, Usuki KY. "Risk of brain metastases in T1-3N0 NSCLC: a population-based analysis." . 2020 Feb 25; 9(1):LMT25. Epub 2020 Feb 25.
Milano MT, Hardy SJ, Chowdhry AK. "Nivolumab without brain radiotherapy is insufficient for the treatment of most patients with brain metastases from clear cell renal cell carcinoma." Annals of translational medicine.. 2019 Dec 0; 7(Suppl 8):S366.
Binkley MS, Brady JL, Hajj C, Chelius M, Chau K, Balogh A, Levis M, Filippi AR, Jones M, Ahmed S, MacManus M, Wirth A, Oguchi M, Vistisen AK, Andraos TY, Ng AK, Aleman BMP, Choi SH, Kirova YM, Hardy S, Reinartz G, Eich HT, Bratman SV, Constine LS, Suh CO, Dabaja B, El-Galaly TC, Hodgson DC, Ricardi U, Yahalom J, Mikhaeel NG, Hoppe RT. "Salvage Treatment and Survival for Relapsed Follicular Lymphoma Following Primary Radiation Therapy: A Collaborative Study on Behalf of ILROG." International journal of radiation oncology, biology, physics.. 2019 Jul 1; 104(3):522-529. Epub 2019 Mar 08.
Books & Chapters
Chapter Title: Hypopituitarism
Book Title: Adult CNS Radiation Oncology
Author List: Hardy S; Shafiq I; Milano M; Vates E; Constine L
Published By: Springer International Publishing AG 2018
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