Brain Toxicity Map May Help Protect Cognition for Cancer Patients

New research is giving radiation oncologists who treat brain tumors a better determination of how to maintain the brain’s functions while still killing cancer.

Ann M. Peiffer, PhD, assistant professor of radiation oncology at Wake Forest Baptist Medical Center (Winston-Salem, NC, USA), and colleagues looked at how radiation treatment to different brain region impacts function to help protect cognition for patients during and after radiation therapy and beyond.

Treating cancerous organs with radiation is devised to give enough of a dose to be toxic to the cancer tumor with minimal impact to the neighboring tissue and circumvent normal tissue death. For treatment of organs such as the lung, liver, or kidney, clinicians know precisely how much radiation to give before organ function is affected.

However, the same is not true for brain tissue, so the researchers worked to develop a “toxicity map” of the brain to preserve function. Dr. Peiffer noted that this is the first attempt to relate treatment dose to brain function, as opposed to brain tissue death. While avoiding healthy tissue death is important, it does not automatically help prevent the cognitive and functional problems associated with cancer treatments. “The issue is the toxicity to the brain and its function, which is cognition or how you think, and these functions are affected at a much lower dose of radiation than what causes tissue death,” Dr. Peiffer said.

The toxicity map was generated by exploiting the data from larger clinical trials held at Wake Forest Baptist. In one of those trials, 57 brain cancer survivors returned six months or more after their radiation treatment to determine whether Donepezil, a drug normally used to improve mental function for those with early Alzheimer’s disease, was effective at improving their cognition. Participants completed cognitive testing upon enrollment, and their scores provided the performance data for the toxicity map. The researchers then went back into the medical records to match participants to their individual radiation dose levels and MRI scans captured before treatment, according to Dr. Peiffer.

“By matching cognitive performance to these measurements, we determined which area of the brain and what dose influenced performance on the cognitive tasks,” Dr. Peiffer said. “This gave us a preliminary look at what areas are important to consider for protecting cognition during our planning for radiation treatment.”

Dr. Peiffer reported that by looking at the irradiation dose received by specific brain regions important to different cognitive functions, tolerance levels related to function could be ascertained. The exposed amount of these vital brain areas were then related to outcomes of specific tests used to assess cognition or the ability of the patients to think and perform tasks, such as remembering a grocery list or what a drawing looked like, she noted. “As technology advances and we are able to spare increasing amounts of normal tissue and important functional structures during treatment, it is important to understand and be able to predict the threshold that we need to maintain to prevent treatment toxicities in function,” Dr. Peiffer said.

New developments in cancer treatment have increased survivorship rates and the length of time individuals are able to live following treatment, according to Dr. Peiffer, and quality of life becomes a very significant matter for these patients. More research, however, is necessary to validate these data, she said.

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