Dose distribution of the brain tissue associated with cognitive functions in high-grade glioma patients

J Jacob; E Clausse; M A Benadjaoud; C Jenny; M Ribeiro; L Feuvret; J-J Mazeron; D Antoni; M-O Bernier; K Hoang-Xuan; D Psimaras; A Carpentier; D Ricard; P Maingon

doi:10.1016/j.canrad.2019.08.009

Dose distribution of the brain tissue associated with cognitive functions in high-grade glioma patients

Cancer Radiother. 2020 Feb;24(1):1-10. doi: 10.1016/j.canrad.2019.08.009. Epub 2020 Jan 25.

Authors

J Jacob¹, E Clausse², M A Benadjaoud³, C Jenny², M Ribeiro⁴, L Feuvret⁵, J-J Mazeron⁵, D Antoni⁶, M-O Bernier⁷, K Hoang-Xuan⁸, D Psimaras⁸, A Carpentier⁹, D Ricard¹⁰, P Maingon⁵

Affiliations

¹ Department of Radiation Oncology, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; CNRS, Service de Santé des Armées, COGNAC-G - Cognition and Action Group, University Sorbonne Paris Cité, 75006 Paris, France. Electronic address: [email protected].
² Department of Medical Physics, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
³ Radiobiology and Regenerative Medicine Research Service, Direction of Human Health, Institut de Radioprotection et de Sûreté Nucléaire, 92260 Fontenay-aux-Roses, France.
⁴ CNRS, Service de Santé des Armées, COGNAC-G - Cognition and Action Group, University Sorbonne Paris Cité, 75006 Paris, France; Department of Neurology 2-Mazarin, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
⁵ Department of Radiation Oncology, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
⁶ Centre Paul Strauss, University of Strasbourg, University Radiotherapy Department, 67000 Strasbourg, France.
⁷ Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, 92260 Fontenay-aux-Roses, France.
⁸ Department of Neurology 2-Mazarin, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; Inserm, CNRS, Institut du Cerveau et de la Moelle Epinière, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
⁹ Inserm, CNRS, Institut du Cerveau et de la Moelle Epinière, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; Department of Neurosurgery, Sorbonne University, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
¹⁰ CNRS, Service de Santé des Armées, COGNAC-G - Cognition and Action Group, University Sorbonne Paris Cité, 75006 Paris, France; Department of Neurology, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France; Service de Santé des Armées, École du Val-de-Grâce, 75005 Paris, France.

PMID: 31992516
DOI: 10.1016/j.canrad.2019.08.009

Abstract

Purpose: The purpose of this prospective dosimetric study was to assess the dose distribution regarding the brain areas implied in cognitive functions using two approaches: volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT).

Patients and methods: Thirty-seven patients were treated using a dual-arc VMAT approach for supratentorial glioblastoma between 2016 and 2018. The total dose of 60Gy in 30 daily fractions was administered to the planning target volume (PTV). The brain structures that play an important role in cognitive physiology, such as the hippocampi, corpus callosum, cerebellum, subventricular zones (SVZ), were delineated. For each patient, a new treatment plan in HT was determined by a second medical physicist in a blindly fashion according to the same dose constraints and priorities. Statistical analyses were performed using the Wilcoxon-signed rank test.

Results: Conformity indexes remained similar with both techniques. The mean values were 0.96 (0.19-1.00) for VMAT and 0.98 (range, 0.84-1.00) for HT, respectively (P=0.73). Significant D_50% reductions were observed with VMAT compared to HT: 14.6Gy (3.8-28.0) versus 17.4Gy (12.1-25.0) for the normal brain (P=0.014); 32.5Gy (10.3-60.0) versus 35.6Gy (17.1-58.0) for the corpus callosum (P=0.038); 8.1Gy (0.4-34.0) versus 12.8Gy (0.8-27.0) for the cerebellum (P<0.001), respectively.

Conclusion: The VMAT approach seemed to improve the sparing of the key brain areas implied in cognitive functions without jeopardizing PTV coverage.

Keywords: Cognitive functions; Fonctions cognitives; Glioma; Gliome; Intensity-modulated radiation therapy; Radiothérapie conformationnelle par modulation d’intensité.

MeSH terms

Adult
Aged
Brain / radiation effects*
Brain Neoplasms / radiotherapy*
Female
Glioblastoma / radiotherapy*
Humans
Male
Middle Aged
Organ Sparing Treatments
Organs at Risk
Prospective Studies
Radiotherapy Dosage*
Radiotherapy, Intensity-Modulated*