Long-term effects of radiation therapy on white matter of the corpus callosum: a diffusion tensor imaging study in children
Despite improving survival rates, children are at risk for long-term cognitive and behavioral difficulties following the diagnosis and treatment of a brain tumor. Surgery, chemotherapy and radiation therapy have all been shown to impact the developing brain, especially the white matter.
The purpose of this study was to determine the long-term effects of radiation therapy on white matter integrity, as measured by diffusion tensor imaging, in pediatric brain tumor patients 2 years after the end of radiation treatment, while controlling for surgical interventions.
Materials and methods
We evaluated diffusion tensor imaging performed at two time points: a baseline 3 to 12 months after surgery and a follow-up approximately 2 years later in pediatric brain tumor patients. A region of interest analysis was performed within three regions of the corpus callosum. Diffusion tensor metrics were determined for participants (n=22) who underwent surgical tumor resection and radiation therapy and demographically matched with participants (n=22) who received surgical tumor resection only.
Analysis revealed that 2 years after treatment, the radiation treated group exhibited significantly lower fractional anisotropy and significantly higher radial diffusivity within the body of the corpus callosum compared to the group that did not receive radiation.
The findings indicate that pediatric brain tumor patients treated with radiation therapy may be at greater risk of experiencing long-term damage to the body of the corpus callosum than those treated with surgery alone.
KeywordsBrain Brain tumor Children Corpus callosum Diffusion tensor imaging Magnetic resonance imaging Radiation White matter
Funding to support this work came from the National Institutes of Health grant numbers R01 CA112182, R01 ES027724 and the Intellectual & Development Disabilities Research Center, at Kennedy Krieger Institute, grant number U54 HD079123.
Compliance with ethical standards
Conflicts of interest
- 2.Ostrom QT, Gittleman H, Fulop J et al (2015) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the united states in 2008-2012. Neuro Oncol 17(Suppl 4):iv1-iv62Google Scholar
- 19.Rueckriegel SM, Driever PH, Blankenburg F et al (2010) Differences in supratentorial damage of white matter in pediatric survivors of posterior fossa tumors with and without adjuvant treatment as detected by magnetic resonance diffusion tensor imaging. Int J Radiat Oncol Biol Phys 76:859–866CrossRefPubMedGoogle Scholar
- 22.Systat Software I (2014) SigmaPlot for windows. Systat Software, Inc., San JoseGoogle Scholar
- 30.Qiu D, Kwong DLW, Chan GCF et al (2007) Diffusion tensor magnetic resonance imaging finding of discrepant fractional anisotropy between the frontal and parietal lobes after whole-brain irradiation in childhood medulloblastoma survivors: reflection of regional white matter radiosensitivity? Int J Radiat Oncol Biol Phys 69:846–851CrossRefPubMedGoogle Scholar
- 45.Patel SK, Yuan W, Mangano FT (2017) Advanced neuroimaging techniques in pediatric hydrocephalus. Pediatr Neurosurg. doi: 10.1159/000454717