Radiation-induced brain damage, impact of Michael Robbins' work and the need for predictive biomarkers.
OBJECTIVE
To review the literature on radiation-induced normal tissue injury in the context of treatment of primary and metastatic brain tumors with a focus on Michael Robbins' work on mechanisms of injury and approaches to mitigation, and also to identify other potential opportunities to improve treatment outcome and quality of life (QOL).


BACKGROUND
Brain tumors remain a significant challenge for patients, their families, the physicians treating them, and researchers seeking more effective treatments. Current treatment of brain tumors involves combinations of radiotherapy with surgery, chemotherapy, and molecularly targeted agents. As patient survival improves with advances in treatment there is an increasing concern for the cognitive deficits that may become apparent months or years after treatment some of which are related to radiation-induced brain damage. One area of Michael Robbins' research was unraveling the mechanisms of radiation-induced cognitive deficits, which formed the basis for the development of some mitigators of radiation injury. Extrapolating from this, new opportunities to identify and develop putative predictive biomarkers of radiation-induced brain damage can be explored.


CONCLUSIONS
Predictive biomarkers of radiation-induced brain injury may enable stratifying patients for customization of treatment and thus aid in improving the QOL and possibly prolonging survival. Here we discuss the challenges involved in leveraging recent advances in radiation-specific biomarker research and translating them to radiotherapy, which for the foreseeable future is likely to remain a cornerstone of the treatment of brain tumors.
Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute , Bethesda, MD.
Pataje G S
PG
Prasanna
Mansoor M
MM
Ahmed
Helen B
HB
Stone
Bhadrasain
B
Vikram
Minesh P
MP
Mehta
C Norman
CN
Coleman
D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001921:Brain / Q000528:radiation effects*; D001930:Brain Injuries / Q000209:etiology*; D001932:Brain Neoplasms / Q000532:radiotherapy*; D006801:Humans; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology*; D018787:Radiation Oncology; D016634:Radiosurgery
D015415:Biomarkers
Radiotherapy; mechanisms; predictive biomarkers; radiation mitigator; radiation-induced brain damage