Photon vs. proton radiochemotherapy: Effects on brain tissue volume and perfusion

Publication date: Available online 19 January 2018
Source:Radiotherapy and Oncology
Author(s): Jan Petr, Ivan Platzek, Frank Hofheinz, Henri J.M.M. Mutsaerts, Iris Asllani, Matthias J.P. van Osch, Annekatrin Seidlitz, Pawel Krukowski, Andreas Gommlich, Bettina Beuthien-Baumann, Christina Jentsch, Jens Maus, Esther G.C. Troost, Michael Baumann, Mechthild Krause, Jörg van den Hoff
Background and purposeTo compare the structural and hemodynamic changes of healthy brain tissue in the cerebral hemisphere contralateral to the tumor following photon and proton radiochemotherapy.Materials and methodsSixty-seven patients (54.9 ±14.0 years) diagnosed with glioblastoma undergoing adjuvant photon (n = 47) or proton (n = 19) radiochemotherapy with temozolomide after tumor resection underwent T1-weighted and arterial spin labeling MRI. Changes in volume and perfusion before and 3 to 6 months after were compared between therapies.ResultsA decrease in gray matter (GM) (−2.2%, P<0.001) and white matter (WM) (−1.2%, P<0.001) volume was observed in photon-therapy patients compared to the pre-radiotherapy baseline. In contrast, for the proton-therapy group, no significant differences in GM (0.3%, P = 0.64) or WM (−0.4%, P = 0.58) volume were observed. GM volume decreased with 0.9% per 10 Gy dose increase (P<0.001) and differed between the radiation modalities (P<0.001). Perfusion decreased in photon-therapy patients (−10.1%, P = 0.002), whereas the decrease in proton-therapy patients, while comparable in magnitude, did not reach statistical significance (−9.1%, P = 0.12). There was no correlation between perfusion decrease and either dose (P = 0.64) or radiation modality (P = 0.94).ConclusionsOur results show that the tissue volume decrease depends on radiation dose delivered to the healthy hemisphere and differs between treatment modalities. In contrast, the decrease in perfusion was comparable for both irradiation modalities. We conclude that proton therapy may reduce brain-volume loss when compared to photon therapy.



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