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Research progress on mechanism and imaging of temporal lobe injury induced by radiotherapy for head and neck cancer

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Abstract

Radiotherapy (RT) is an effective treatment for head and neck cancer (HNC). Radiation-induced temporal lobe injury (TLI) is a serious complication of RT. Late symptoms of radiation-induced TLI are irreversible and manifest as memory loss, cognitive impairment, and even temporal lobe necrosis (TLN). It is currently believed that the mechanism of radiation-induced TLI involves microvascular injury, neuron and neural stem cell injury, glial cell damage, inflammation, and the production of free radicals. Significant RT-related structural changes and dose-dependent changes in gray matter (GM) and white matter (WM) volume and morphology were observed through computed tomography (CT) and magnetic resonance imaging (MRI) which were common imaging assessment tools. Diffusion tensor imaging (DTI), dispersion kurtosis imaging (DKI), susceptibility-weighted imaging (SWI), resting-state functional magnetic resonance (rs-fMRI), magnetic resonance spectroscopy (MRS), and positron emission tomography (PET) can be used for early diagnosis and prognosis evaluation according to functional, molecular, and cellular processes of TLI. Early diagnosis of TLI is helpful to reduce the incidence of TLN and its related complications. This review summarizes the clinical features, mechanisms, and imaging of radiation-induced TLI in HNC patients.

Key Points

• Radiation-induced temporal lobe injury (TLI) is a clinical complication and its symptoms mainly include memory impairment, headache, and cognitive impairment.

• The mechanisms of TLI include microvascular injury, cell injury, and inflammatory and free radical injury. Significant RT-related structural changes and dose-dependent changes in TL volume and morphology were observed through CT and MRI.

• SWI, MRS, DTI, and DKI and other imaging examinations can detect anatomical and functional, molecular, and cellular changes of TLI.

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Abbreviations

Ang:

Angiopoietin

Ang-2:

Angiopoietin-2

BBB:

Blood-brain barrier

CCR2:

Chemokine (C-C motif) receptor 2

CMBs:

Cerebral microbleeds

CNS:

Central nervous system

COX-2:

Cyclocyte-2

CT:

Computed tomography

CXCR4:

CXC chemokine receptor 4

D1cc :

The dose delivered to the 1-cm3 volume

DKI:

Dispersion kurtosis imaging

DTI:

Diffusion tensor imaging

ERK1/2:

Extracellular regulated protein kinases 1/2

fALFF:

Fractional amplitude of low-frequency fluctuation

GM:

Gray matter

hESC:

Human embryonic stem cells

HIT:

Heavy ion therapy

hMSC:

Human mesenchymal stem cells

HNC:

Head and neck cancer

IL:

Interleukin

IMRT:

Intensity-modulated radiation therapy

LPS:

Lipopolysaccharide

MEK1:

Mitogen-activated protein kinase kinase 1

MRI:

Magnetic resonance imaging

MRS:

Magnetic resonance spectroscopy

NF-κB:

Nuclear factor kappa-B

NGF:

Nerve growth factor

NPC:

Nasopharyngeal carcinoma

NSCs:

Neural stem cells

P2Y6R:

Purinergic receptor P2Y6 receptor

PBT:

Proton beam therapy

PET:

Positron emission tomography

PET:

Positron emission tomography

RIBI:

Radiation-induced brain injury

ROS:

Reactive oxygen species

rs-fMRI:

Resting-state functional magnetic resonance

RT:

Radiotherapy

SDF-1:

Stromal cell-derived factor 1

SWI:

Susceptibility-weighted imaging

T1WI:

T1-weighted image

T2WI:

T2-weighted image

TL:

Temporal lobe

TLI:

Temporal lobe injury

TLN:

Temporal lobe necrosis

TNF-α:

Tumor necrosis factor-alpha

VEGF:

Vascular endothelial growth factor

VMAT:

Volumetric modulated arc therapy

WM:

White matter

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Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This work was supported by the National Natural Science Foundation of China (Grant number 81570344); National Key R & D Program of China (Grant number 2017YFC0112100), the Education Department Foundation of Jilin Province (Grant number JJKH20201036KJ); the Health and Family Planning Commission of Jilin Province Foundations (Grant numbers 2016Q034 and 2017J11); the Fundamental Research Funds for the Central Universities of Jilin University; and the Jilin Provincial Science and Technology Foundations (Grant number 20180414039GH and 20190201200JC).

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  1. Department of Radiation Oncology, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China

    Zhuangzhuang Zheng, Bin Wang, Qin Zhao, Yuyu Zhang, Jinlong Wei & Xin Jiang

  2. Jilin Provincial Key Laboratory of Radiation Oncology& Therapy, The First Hospital of Jilin University, Changchun, 130021, China

    Zhuangzhuang Zheng, Bin Wang, Qin Zhao, Yuyu Zhang, Jinlong Wei & Xin Jiang

  3. NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, 130021, China

    Zhuangzhuang Zheng, Bin Wang, Qin Zhao, Yuyu Zhang, Jinlong Wei & Xin Jiang

  4. Department of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA

    Lingbin Meng

  5. Key Laboratory of Pathobiology, Ministry of Education, Jilin University, 126 Xinmin Street, Changchun, 130021, China

    Ying Xin

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  1. Zhuangzhuang Zheng
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Zheng, Z., Wang, B., Zhao, Q. et al. Research progress on mechanism and imaging of temporal lobe injury induced by radiotherapy for head and neck cancer. Eur Radiol 32, 319–330 (2022). https://doi.org/10.1007/s00330-021-08164-6

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