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Radiation-Induced Cerebral Microbleeds in Pediatric Patients With Brain Tumors Treated With Proton Radiation Therapy

Stephen F Kralik1, Todd R Mereniuk2, Laurent Grignon1

  • 1Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.

International Journal of Radiation Oncology, Biology, Physics
|August 10, 2018
PubMed

Insights

Cerebral microbleeds (CMBs) are common in pediatric brain tumor patients after proton beam radiation therapy (PBT). Younger age and higher radiation doses increase CMB risk, similar to photon therapy.

Area of Science:

  • Pediatric Oncology
  • Radiation Oncology
  • Neuro-oncology

Background:

  • Proton beam radiation therapy (PBT) is increasingly used for pediatric brain tumors.
  • Limited data exists on radiation-induced cerebral microbleeds (CMBs) in this population.

Purpose of the Study:

  • Evaluate the incidence of CMBs in pediatric brain tumor patients treated with PBT.
  • Identify risk factors associated with CMB development.
  • Describe the imaging appearance of CMBs.

Main Methods:

  • Retrospective study of 100 pediatric patients treated with PBT.
  • CMBs diagnosed using serial MRI, including susceptibility-weighted imaging.
  • Analysis of radiation therapy plans and clinical records for risk factors.

Main Results:

  • 43% of patients developed CMBs within 1 year, increasing to 81% by 5 years.
  • Most CMBs (87%) occurred in areas receiving ≥30 Gy.
  • Risk factors: younger age at PBT, higher maximum dose, and greater brain volume exposed to ≥30 Gy.

Conclusions:

  • CMBs are frequent in pediatric patients post-PBT, developing within years.
  • Younger age, higher radiation dose, and larger irradiated brain volumes are significant risk factors.
  • Findings mirror CMB development seen with photon radiation therapy.
Abstract

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