title: Neuroanatomical target theory as a predictive model for radiation-induced cognitive decline.
abstract: OBJECTIVE
  In a retrospective review to assess neuroanatomical targets of radiation-induced cognitive decline, dose volume histogram (DVH) analyses of specific brain regions of interest (ROI) are correlated to neurocognitive performance in 57 primary brain tumor survivors.
  
  
  METHODS
  Neurocognitive assessment at baseline included Trail Making Tests A/B, a modified Rey-Osterreith Complex Figure, California or Hopkins Verbal Learning Test, Digit Span, and Controlled Oral Word Association. DVH analysis was performed for multiple neuroanatomical targets considered to be involved in cognition. The %v10 (percent of ROI receiving 10 Gy), %v40, and %v60 were calculated for each ROI. Factor analysis was used to estimate global cognition based on a summary of performance on individual cognitive tests. Stepwise regression was used to determine which dose volume predicted performance on global factors and individual neurocognitive tests for each ROI.
  
  
  RESULTS
  Regions that predicted global cognitive outcomes at doses <60 Gy included the corpus callosum, left frontal white matter, right temporal lobe, bilateral hippocampi, subventricular zone, and cerebellum. Regions of adult neurogenesis primarily predicted cognition at %v40 except for the right hippocampus which predicted at %v10. Regions that did not predict global cognitive outcomes at any dose include total brain volume, frontal pole, anterior cingulate, right frontal white matter, and the right precentral gyrus.
  
  
  CONCLUSIONS
  Modeling of radiation-induced cognitive decline using neuroanatomical target theory appears to be feasible. A prospective trial is necessary to validate these data.
authors: Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA. apeiffer@wakehealth.edu
authors: Ann M
authors: AM
authors: Peiffer
authors: C Marc
authors: CM
authors: Leyrer
authors: Dana M
authors: DM
authors: Greene-Schloesser
authors: Elaine
authors: E
authors: Shing
authors: William T
authors: WT
authors: Kearns
authors: William H
authors: WH
authors: Hinson
authors: Stephen B
authors: SB
authors: Tatter
authors: Edward H
authors: EH
authors: Ip
authors: Stephen R
authors: SR
authors: Rapp
authors: Mike E
authors: ME
authors: Robbins
authors: Edward G
authors: EG
authors: Shaw
authors: Michael D
authors: MD
authors: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011832:Radiation Injuries / Q000150:complications* / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects*; D012044:Regression Analysis; D017741:Survivors
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