Microstructural injury to corpus callosum and intrahemispheric white matter tracts correlate with attention and processing speed decline after brain radiation Journal Article

Authors: Huynh-Le, M. P.; Tibbs, M. D.; Karunamuni, R.; Salans, M.; Tringale, K. R.; Yip, A.; Connor, M.; Simon, A. B.; Vitzthum, L. K.; Reyes, A.; Macari, A. C.; Moiseenko, V.; McDonald, C. R.; Hattangadi-Gluth, J. A.
Article Title: Microstructural injury to corpus callosum and intrahemispheric white matter tracts correlate with attention and processing speed decline after brain radiation
Abstract: Purpose: The corpus callosum (CC) and intrahemispheric white matter tracts (IHWM) subserve critical aspects of attention and processing speed. We analyzed imaging biomarkers of microstructural injury within these regions and association with attention and processing speed performance before and after radiation therapy in primary brain tumor patients. Methods and Materials: In a prospective clinical trial, 44 primary brain tumor patients underwent cognitive testing and magnetic resonance imaging/diffusion-weighted imaging at baseline (pre-radiation therapy) and 3-, 6-, and 12-months post-radiation therapy. CC (subregions, total) and IHWM tracts (left/right without CC, total) were autosegmented; tumor, tumor bed, and edema were censored. Biomarkers included volume changes (cm3), mean diffusivity ([MD]; higher values indicate white matter injury), fractional anisotropy ([FA]; lower values indicate white matter injury). Reliable-change indices measured changes in attention (Weschler Adult Intelligence Scale [WAIS-IV] digits-forward; Delis-Kaplan Executive Function System Trail Making [D-KEFS-TM] visual-scanning), and processing speed (WAIS-IV coding; D-KEFS-TM number-sequencing, letter-sequencing), accounting for practice effects. Linear mixed-effects models evaluated associations between mean radiation dose and biomarkers (volume, MD, FA) and imaging biomarkers and neurocognitive performance. Statistics were corrected for multiple comparisons. Results: Processing speed declined at 6 months following radiation therapy (number sequencing, letter sequencing; P < .04). Seizures and antiepileptic drug therapy were associated with lower visual-scanning attention reliable-change indices at 6 months (P = .039). Higher radiation dose correlated with smaller midanterior CC volume (P = .023); lower FA in posterior CC, anterior CC, and total CC (all P < .03); and higher MD in anterior CC (P = .012). Smaller midanterior CC and left IHWM volume correlated with worse processing speed (coding, letter-sequencing, number-sequencing; all P < .03). Higher FA in right, left, and total IHWM correlated with better coding scores (all P < .01). Lower FA in total IHWM (P = .009) was associated with worse visual-scanning attention scores. Higher FA in midposterior CC (P = .029) correlated with better digits-forward attention scores. Conclusions: The CC demonstrated radiation dose-dependent atrophy and WM injury. Microstructural injury within the CC and IHWM was associated with attention and processing speed decline after radiation therapy. These areas represent possible avoidance regions for preservation of attention and processing speed. © 2021 Elsevier Inc.
Keywords: scanning; magnetic resonance imaging; biomarkers; radiotherapy; brain; radiation effects; tumors; drug therapy; antiepileptic drugs; fractional anisotropy; speed; primary brain tumors; executive function; methods and materials; linear mixed-effects model; multiple comparison; white matter tracts
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 110
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2021-06-01
Start Page: 337
End Page: 347
Language: English
DOI: 10.1016/j.ijrobp.2020.12.046
PUBMED: 33412257
PROVIDER: scopus
PMCID: PMC8162991
Notes: Conference Paper -- Export Date: 1 June 2021 -- Source: Scopus
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