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Avoiding Damage to Neurocognitive Regions of the Brain During Cranial Radiation

By MedImaging International staff writers
Posted on 30 Nov 2009

Radiation oncologists are trying to find ways to avoid damage to the critically important hippocampus and limbic circuit of the brain when cranial radiation is required to treat existing or potential metastatic tumors. The goal is to spare these areas, which are responsible for short-term memory, as well as emotions, motivation, and a variety of executive functions, such as decision-making and planning.

Cranial radiation is used to destroy tumors that have spread to the brain, which occurs in 20% to 25% of all cancer patients. It is also used prophylactically to prevent the development of overt intracranial metastases in patients diagnosed with small-cell lung carcinoma.

But there is a flipside to the treatment. Because the hippocampus and the limbic area are irradiated along with the rest of the brain, the treatment frequently causes memory lapses, difficulty with executive planning, and poor fine motor control. The consequences can be devastating for patients, whose quality of life is deeply affected.

In a review of records for 107 patients with 700 lesions, the team of radiation oncologists at Rush University Medical Center (Chicago, IL, USA) found that metastases had occurred in the hippocampus in only 0.8% of the cases, and in the limbic circuit in fewer than 3% of cases. That finding encouraged them to determine whether it might be possible to deliver cranial radiation to the brain, but not to these specific areas--eliminating metastases or potential metastases with radiation but sparing the hippocampus and the limbic areas, where metastases were unlikely to occur.

In their feasibility study, the researchers were able to demonstrate that the hippocampus and limbic circuit can be largely spared using sophisticated equipment that targets the radiation to specific areas. The study's results were presented at the annual meeting of the American Society for Radiation Oncology, which is being held November 1-5, 2009, in Chicago, IL, USA. "We have shown that it is possible to reduce the dose of radiation to this area, while treating the rest of the brain, where the cancer is located, at full dose,” said Dr. Arnold Herskovic, principal investigator of the study.

The study was performed using a TomoTherapy (Madison, WI, USA) Hi-Art system, which enables the treatment of tumors with image-guided radiation therapy. The researchers expect to start a clinical trial of the new procedure soon to determine whether in fact it can both prevent or treat brain metastases and minimize long-term neurocognitive consequences.

Related Links:
Rush University Medical Center
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68 (33.140182495117): SELECT fid FROM jos_deeppockets WHERE id=294726646 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726646 AND published='1' LIMIT 1

69 (32.901763916016): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (360.01205444336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (276.08871459961): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (50.067901611328): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (29.802322387695): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.901763916016): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

105 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

106 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

110 (49.114227294922): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (561.95259094238): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (595.8080291748): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (361.91940307617): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

116 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

117 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

118 (178.09867858887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

119 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

120 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

121 (35.04753112793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

122 (315.90461730957): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 20144.939422607): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (617.98095703125): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726646 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726646 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7719.9935913086): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (68.902969360352): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (44.822692871094): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (326.87187194824): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (33.855438232422): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (362.87307739258): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (56.028366088867): SELECT name FROM jos_deeppockets WHERE id=211

138 (37.908554077148): SELECT name FROM jos_deeppockets WHERE id=211

139 (566.00570678711): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (445.12748718262): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

142 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

143 (!!!!! 8803.129196167): TRUNCATE TABLE jos_trademed_module

144 (94.175338745117): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (55.074691772461): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726646 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1070.9762573242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (227.92816162109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

149 (223.87504577637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

150 (!!!!! 2282.8578948975): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (673.05564880371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

152 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

153 (64.13459777832): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726646 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726646 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (53.167343139648): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (34.093856811523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (474.21455383301): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (698.08959960938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

158 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726646 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726646 AND published='1' LIMIT 1

159 (164.98565673828): select jos_twitters.link from jos_twitters where cat=10

160 (913.85841369629): select jos_facebook.link from jos_facebook where cat=10

161 (64.13459777832): select jos_google_plus.link from jos_google_plus where cat=10

162 (43.153762817383): select jos_linkedin.link from jos_linkedin where cat=10

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