© 2005 by the Society forNeuro-Oncology
Atypical white matter volume development in children followingcraniospinal irradiation
Departments of Radiological Sciences (W.E.R., J.O.G.,J.W.L., L.E.K.), Behavioral Medicine (S.L.P.,R.K.M.), Biostatistics (S.W., X.X.), and Hematology-Oncology (A.G.), St. Jude Children's ResearchHospital, Memphis, TN 38105; Departments of Electricaland Computer Engineering (W.E.R.) and BiomedicalEngineering (W.E.R.), University of Memphis, Memphis, TN 38152; USA
2 Address correspondence to Wilburn E. Reddick, Department of RadiologicalSciences (MS #212), St. Jude Children's Research Hospital, 332 N. LauderdaleSt., Memphis, TN 38105-2794, USA(gene.reddick{at}stjude.org).
Most children with medulloblastoma (MB), the second most common pediatricbrain tumor, have a 70% probability of survival. However, survivors whoreceive aggressive therapy are at significant risk of cognitive deficits thathave been associated with lower volumes of normalappearing white matter(NAWM). We hypothesized that cranial irradiation inhibited normal brain volumedevelopment in these survivors. We retrospectively analyzed 324 MRI studies of52 patients with histologically proven MB treated with surgery and 35 to 40 Gycraniospinal irradiation, with or without chemotherapy. The volume of NAWM andthat of cerebrospinal fluid were quantified from a single index section andcompared with those of healthy, age-similar control subjects. A quadraticrandom coefficient model was used to identify trends in brain volume withincreasing age. Patients treated for MB at younger ages demonstratedsubstantially less development of NAWM volume than did their healthy peers.Younger age at the time of irradiation and the need for a ventricular shuntwere significantly associated with reduced NAWM volume. NAWM and craniospinalfluid volume differences between patients who had shunts and those withoutresolved over a period of four to five years. NAWM volume is known to beassociated with neurocognitive test performance, which shows deficienciesafter cranial irradiation early in life. Therefore, volumetric monitoring ofbrain development can be used to guide the care of survivors, assess thetoxicity of previous and current clinical trials, and aid in the design oftherapies that minimize toxicity.
Received January 22, 2004; Accepted June 29, 2004
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