Top Line: The indications for whole brain radiation (WBRT) are becoming ever narrower as alternative techniques such as radiosurgery and hippocampus-sparing IMRT prove to result in comparable disease control with fewer neurocognitive sequelae.
The Story: But what is it exactly about standard WBRT that causes such negative effects in the minds of patients, particularly the elderly? This fascinating imaging study retrospectively looked for clues across the standard pre- and post-treatment brain MRIs performed on 72 patients receiving WBRT over the last decade at Northwestern. It used a recently-developed AI platform designed to accurately predict a patient’s age by analyzing brain surface morphology on MRI as a measure of cortical volume loss. When compared to thousands of healthy controls, patients aged nearly 10x(!) following WBRT. Interestingly, among those receiving WBRT, the hippocampi aged nearly 9x faster after conventional treatment (n=55) than with hippocampus-sparing IMRT(n=17). This compelling concept of “rapid aging” fits well with the observation of particularly devastating cognitive demise after WBRT for patients who have already begun experiencing age-related neurocognitive decline.
TBL: Sophisticated imaging analyses suggest whole brain radiation significantly accelerates normal age-related cognitive decline with each substructure affected in a dose-dependent manner. | Rammohan, Neuro Oncol 2023
The Story: But what is it exactly about standard WBRT that causes such negative effects in the minds of patients, particularly the elderly? This fascinating imaging study retrospectively looked for clues across the standard pre- and post-treatment brain MRIs performed on 72 patients receiving WBRT over the last decade at Northwestern. It used a recently-developed AI platform designed to accurately predict a patient’s age by analyzing brain surface morphology on MRI as a measure of cortical volume loss. When compared to thousands of healthy controls, patients aged nearly 10x(!) following WBRT. Interestingly, among those receiving WBRT, the hippocampi aged nearly 9x faster after conventional treatment (n=55) than with hippocampus-sparing IMRT(n=17). This compelling concept of “rapid aging” fits well with the observation of particularly devastating cognitive demise after WBRT for patients who have already begun experiencing age-related neurocognitive decline.
TBL: Sophisticated imaging analyses suggest whole brain radiation significantly accelerates normal age-related cognitive decline with each substructure affected in a dose-dependent manner. | Rammohan, Neuro Oncol 2023