Publication details

Post-WBRT cognitive impairment and hippocampal neuronal depletion measured by in vivo metabolic MR spectroscopy: Results of prospective investigational study

Authors

POSPÍŠIL Petr KAZDA Tomáš HYNKOVÁ Ludmila BULIK Martin DOBIASKOVA M. BURKOŇ Petr LAACK N.N. ŠLAMPA Pavel JANČÁLEK Radim

Year of publication 2017
Type Article in Periodical
Magazine / Source Radiotherapy and Oncology, Journal of the European Society for Therapeutic Radiology and Oncology
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1016/j.radonc.2016.12.013
Field Oncology and hematology
Keywords Hippocampus; Radiation injury; Neurocognitive function; Magnetic resonance spectroscopy
Description Background and purpose: The aim of this prospective study is to evaluate post -whole brain radiotherapy (WBRT) changes in hippocampal concentration of N-acetylaspartate (h-tNAA) as a marker of neuronal loss and to correlate those changes to neurocognitive function. Material and methods: Thirty-five patients with brain metastases underwent baseline single slice multivoxel MR spectroscopy (MRS) examination for measurement of hippocampal h-tNAA together with baseline battery of neurocognitive tests focused on memory (Auditory Verbal Learning Test and Brief Visuospatial Memory Test - Revised) as well as quality of life questionnaires (EORTC QLQ-C30 a EORTC QLQ-BN20). Eighteen patients completed follow-up evaluation four months after standard WBRT (2 laterolateral fields, 10 x 3.0 Gy, 6 MV photons) and were included in this analysis. MRS and cognitive examinations were repeated and compared to baseline measurements. Results: Statistically significant decreases in h-tNAA were observed in the right (8.52-7.42 mM; -12.9%, 95%Cl: -7.6 to -16.4%) as well as in the left hippocampus (8.64-7.60 mM; -12%, 95%Cl: -7.9 to -16.2%). Statistically significant decline was observed in all AVLT and BVMT-R subtests with exception of AVLT_Recognition. Quality of life declined after WBRT (mean Delta-14.1 +/- 20.3 points in transformed 0100 point scale; p = 0.018) with no correlation to changes in hippocampal metabolite concentrations. Moderate positive correlation was observed between left h-tNAA concentration decrease and AVLT_TR decline (r = +0.32; p = 0.24) as well as with AVLT_DR (r = +0.33; p = 0.22) decline. Changes in right htNAA/Cr negatively correlated with AVLT_DR (r = -0.48; p = 0.061). No correlation between right hippocampus h-tNAA and memory decline (AVLT) was observed. Conclusions: Our results suggest hippocampal NAA concentrations decline after WBRT and MRS may be a useful biomarker for monitoring neuronal loss after radiotherapy. 2016 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 122 (2017) 373-379

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