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Delayed leukoencephalopathy of non-small cell lung cancer patients with brain metastases underwent whole brain radiation therapy

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Abstract

To explore the incidence, MR imaging findings, dynamic developing process of delayed leukoencephalopathy (DLE) in non-small cell lung cancer (NSCLC) patients with brain metastases patients who undergone whole brain radiation (WBRT) therapy, we retrospectively reviewed 48 NSCLC patients who underwent WBRT for brain metastases from January 2010 through June 2015 and had evaluable magnetic resonance imaging after treatment. The DLE were graded using a scale to evaluate T2-FLAIR (fluid attenuated image recovery) images: grade 1 = little or no white matter hyperintensity, grade 2 = limited periventricular hyperintensity and grade 3 = diffuse white matter hyperintensity. 48 NSCLC patients with brain metastases were enrolled. The median age of these patients was 55.7 years (range 33–75 years). The median follow-up was 12 months. The characteristic MR imaging of DLE in those patients was bilaterally diffuse white matter T2 hyperintensity around the periventricular areas without enhancement, sparing from U-fiber, callosum and gray matter structure. The incidence of DLE developed 6.25 % (3/48), 30.00 % (12/40), 48.39 % (15/31), 61.90 % (13/21), 85.71 % (6/7), 100 % (3/3) in those patients who were followed up for 3, 6, 9, 12, 24, 36 months, respectively. Through increased understanding of it, it may be possible to help clinicians develop further therapeutic strategies to maximize benefit while limiting potential long term toxicities. These data supplement existing reports regarding the late effects of WBRT in NSCLC patients with brain metastasis.

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References

  1. NSCLC Meta-analysis Collaborative Group (2014) Preoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet 383:1561–1571

    Article  PubMed Central  Google Scholar 

  2. Postmus PE, Haaxma-Reiche H, Smit EF et al (2000) Treatment of brain metastases of small-cell lung cancer: comparing teniposide and teniposide with whole-brain radiotherapy-a phase III study of the European Organization for the Research and Treatment of Cancer. Lung Cancer Cooperative Group. J Clin Oncol 18:3400–3408

    CAS  PubMed  Google Scholar 

  3. Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2005) Radiosurgery with or without whole-brain radiotherapy for brain metastases: the patients’ perspective regarding complications. Am J Clin Oncol 28:173–179

    Article  PubMed  Google Scholar 

  4. Burger PC, Mahley MS Jr, Dudka L, Vogel FS (1979) The morphologic effects of radiation administered therapeutically for intracranial gliomas: a postmortem study of 25 cases. Cancer 44:1256–1272

    Article  CAS  PubMed  Google Scholar 

  5. Panagiotakos G, Alshamy G, Chan B et al (2007) Long-term impact of radiation on the stem cell and oligodendrocyte precursors in the brain. PLoS ONE 2:e588

    Article  PubMed Central  PubMed  Google Scholar 

  6. Monaco EA, Faraji AH, Berkowitz O et al (2013) Leukoencephalopathy after whole-brain radiation therapy plus radiosurgery versus radiosurgery alone for metastatic lung cancer. Cancer 1:226–232

    Article  Google Scholar 

  7. Mornex F, Thomas L, Mohr P et al (2003) A prospective randomized multicentre phase III trial of fotemustine plus whole brain irradiation versus fotemustine alone in cerebral metastases of malignant melanoma. Melanoma Res 13:97–103

    Article  CAS  PubMed  Google Scholar 

  8. Ebi J, Sato H, Nakajima M et al (2012) Incidence of leukoencephalopathy after whole-brain radiation therapy for brain metastases. Int J Radiat Oncol Biol Phys 85:1212–1217

    Article  PubMed  Google Scholar 

  9. Stokes TB, Niranjan A, Kano H et al (2015) White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery. J Neurooncol 121:583–590

    Article  CAS  PubMed  Google Scholar 

  10. Fujii O, Tsujino K, Soejima T et al (2006) White matter changes on magnetic resonance imaging following whole-brain radiotherapy for brain metastases. Radiat Med 24:345–350

    Article  PubMed  Google Scholar 

  11. Kohama Steven G, Rosene Douglas L, Sherman Larry S (2012) Age-related changes in human and non-human primate white matter: from myelination disturbances to cognitive decline. AGE 34:1093–1110

    Article  PubMed Central  PubMed  Google Scholar 

  12. Tofilon PJ, Fike JR (2000) The radioresponse of the central nervous system: a dynamic process. Radial Res 53:357–370

    Article  Google Scholar 

  13. Schultheiss TE, Kun LE, Ang KK, Stephens LC (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31:1093–1112

    Article  CAS  PubMed  Google Scholar 

  14. Komarnicky LT, Phillips TL, Martz K, Asbell S, Isaacson S, Urtasun R (1991) A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain metastases (RTOG-7916). Int J Radiat Oncol Biol Phys 20:53–58

    Article  CAS  PubMed  Google Scholar 

  15. Phillips TL, Scott CB, Leibel SA, Rotman M, Weigensberg IJ (1995) Results of a randomized comparison of radiotherapy and bromodeoxyuridine with radiotherapy alone for brain metastases: report of RTOG trial 89-05. Int J Radiat Oncol Biol Phys 33:339–348

    Article  CAS  PubMed  Google Scholar 

  16. Meyers CA, Smith JA, Bezjak A et al (2004) Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 22:157–165

    Article  CAS  PubMed  Google Scholar 

  17. Brown PD, Pugh S, Laack NN et al (2013) Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro Oncol 15:1429–1437

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Wefel JS, Kayl AE, Meyers CA (2004) Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target. Br J Cancer 90:1691–1696

    PubMed Central  CAS  PubMed  Google Scholar 

  19. Kutita H, Kawahara N, Asai A et al (2001) Radiation-induced apoptosis of oligodendrocytes in the adult rat brain. Neurol Res 23:869–874

    Article  Google Scholar 

  20. Correal DD, Maron L, Harder H et al (2007) Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines. Ann Oncol 18:1145–1151

    Article  Google Scholar 

  21. Aoyama H, Tago M, Kato N et al (2007) Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 68:1388–1395

    Article  PubMed  Google Scholar 

  22. Chang EL, Wefel JS, Hess KR et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044

    Article  PubMed  Google Scholar 

  23. Suh JH (2014) Hippocampal-avoidance whole-brain radiation therapy: a new standard for patients with brain metastases? J Clin Oncol 32:3789–3791

    Article  PubMed  Google Scholar 

  24. Gondi V, Pugh SL, Tome WA et al (2014) Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol 32:3810–3816

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by Grand No. 81471654 from the National Natural Science Foundation of China.

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Authors and Affiliations

  1. Department of Radiology, Guangdong Academy of Medical Sciences, Guangdong General Hospital, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, People’s Republic of China

    Xiaoling Zhong, Biao Huang, Jieying Feng, Wanqun Yang & Hongjun Liu

  2. Southern Medical School, 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, Guangdong, People’s Republic of China

    Xiaoling Zhong

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  1. Xiaoling Zhong
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  2. Biao Huang
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  3. Jieying Feng
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  5. Hongjun Liu
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Correspondence to Biao Huang.

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Zhong, X., Huang, B., Feng, J. et al. Delayed leukoencephalopathy of non-small cell lung cancer patients with brain metastases underwent whole brain radiation therapy. J Neurooncol 125, 177–181 (2015). https://doi.org/10.1007/s11060-015-1888-9

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  • DOI: https://doi.org/10.1007/s11060-015-1888-9

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