title: Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques.
abstract: Neurocognitive dysfunction is the leading cause of reduced quality of life in long-term survivors of paediatric brain tumours. Radiotherapy is one of the main contributors to neurocognitive sequelae. Current approaches for prevention and reduction of neurocognitive dysfunction include avoidance of radiotherapy in young children and reduction of the radiotherapy dose and volume of brain irradiated. Substantial advances have been made in brain imaging, especially with functional imaging and fibre tracking with the use of diffusion tensor imaging. Radiotherapy techniques for photon therapy have also evolved, with widespread use of techniques such as image-guided radiotherapy, volumetric modulated arc therapy, helical tomotherapy, and adaptive radiotherapy. The number of proton beam and heavy ion therapy facilities is increasing worldwide and there is great enthusiasm for clinical use of advanced MRI-guided radiotherapy systems. Here, we review the potential role of modern imaging and innovative radiotherapy techniques in minimisation of neurocognitive sequelae in children with brain tumours, and discuss various strategies to integrate these advances to drive further research.
authors.affiliation: Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK. Electronic address: thankamma.ajithkumar@addenbrookes.nhs.uk.
authors.forename: Thankamma
authors.initials: T
authors.lastname: Ajithkumar
authors.affiliation: Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Price
authors.affiliation: Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Horan
authors.affiliation: Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Amos
authors.initials: A
authors.lastname: Burke
authors.affiliation: Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jefferies
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy*; D002648:Child; D003072:Cognition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D006801:Humans; D011788:Quality of Life; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D017741:Survivors