鼻咽癌放疗后早期脑白质微观损伤DTI观察及其与受量关系研究

doi:10.3760/cma.j.issn.1004-4221.2019.11.010

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Abstract

Objective To explore the correlation between microdamage in white matter and radiotherapy dose at early stage after radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC). Methods Thirty-three patients who were initially diagnosed with NPC were recruited and received diffusion tensor imaging (DTI) scan and neuro-cognitive scale test within 1 week before RT and the first day after RT. DTI-related characteristic parameters including fractional anisotropy (FA),mean diffusivity (MD),axial diffusivity (λ‖),and radial diffusivity (λ⊥) were calculated based on whole-brain voxel analysis method. Paired t-test was conducted to evaluate statistical significance between pre-RT and post-RT groups. In the subgroup analysis, all the subjects were divided into 3 groups according to the average dose of temporal lobe, and each group was set with an equal dose interval range. The DTI-related parameters of whole brain pre-RT and post-RT in each group were statistically compared. All the statistical results were corrected by FDR with a threshold of P<0.05 and clusters>100. Results FA, MD, λ‖ and λ⊥in the post-RT group significantly differed compared with those in the pre-RT group (P<0.05). The values of FA, MD, λ‖ and λ⊥were 0.455±0.016,(9.893±0.403)×10^-4,(13.441±0.412)×10^-4 and (8.231±0.429)×10^-4, respectively. Subgroup analysis showed that the extent and degree of λ‖ and λ⊥ changes were exacerbated with the increase of the average dose of temporal lobe after RT. Particularly in high-dose group, the average dose range was 25-35Gy and the extent of regions with significant changes was significantly larger than those in the medium-dose (15-25Gy) and low-dose groups (5-15Gy)(P<0.05). Conclusions DTI can be utilized to detect"normal" brain tissue microdamage in NPC patients at early stage after RT. The average radiation dose of temporal lobe may be one of the reasons for the severity of cerebral microdamage. In the future, DTI technique may be useful for guiding exposure dose of organs at risk during RT planning and to evaluate the cohort with a high risk of cerebral microdamage at early stage after RT, thereby protecting normal cerebral tissues to the maximum extent.

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	Articles by authors
	Ren Wenting
	Sun Chao
	Wu Runye
	Cao Ying
	Liang Xin
	Xu Yingjie
	Ma Pan
	Han Fei
	Lu Ting
	Yi Junlin
	Dai Jianrong

Key words： Diffusion tensor imaging Nasopharyngeal neoplasm/radiotherapy Radiation-induced brain injury Dosimetry

Received: 31 March 2019

Fund:

Beijing Hope Run Special Fund of Cancer Foundation of China (LC2018B02);National Natural Science Foundation of China (81402528,11275270)

Corresponding Authors: Dai Jianrong,Email:dai_jianrong@163.com;Yi Junlin,Email:yijunlin1969@163.com

Cite this article:

Ren Wenting,Sun Chao,Wu Runye et al. The microdamage of "morphologically normal white matter" in patients with nasopharyngeal carcinoma after radiotherapy and its correlation with the irradiation dose[J]. Chinese Journal of Radiation Oncology, 2019, 28(11): 843-848.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2019.11.010 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2019/V28/I11/843

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