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Published on: December 28, 2017
Functional Imaging for Identification of Functionally Critical Brain Regions to Spare in Glioma Radiation Therapy
Li Wen Yeo1,2, John T Ryan2
1Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore.
Introduction:
Beyond improving target delineation, functional imaging holds significant promise in identifying critical functional brain regions. It enables a more personalised approach to radiation therapy (RT) planning, where organs-at-risk can be spared more effectively, potentially preserving neurocognitive function and quality of life in patients with glioma. This systematic review aims to identify the role of functional imaging in preserving neurocognitive function in patients with glioma undergoing RT.
Methods:
A systematic review was conducted in December 2024 according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Searches were performed in Scopus, MEDLINE and EMBASE using medical subject headings and keywords related to glioma, functional imaging, cognition and RT. Only English-language publications were included. The Critical Appraisal Skills Programme (CASP) checklist was used to assess the validity and applicability of the studies included in this systematic review.
Results:
Five studies published between 2019 and 2023 were included in the review. The studies included retrospective cohort studies (n = 2), a pilot study (n = 1), a cross-sectional study (n = 1) and a theoretical study (n = 1). Quality assessment using the CASP checklist indicated moderate methodological quality, with limitations including small sample sizes, predominantly retrospective designs and limited prospective validation of neurocognitive outcomes. Functional imaging was shown to reduce the dose to cognitive areas and potentially protect important cognitive functions.
Conclusion:
Functional imaging identifies critical cognitive regions in the brain and guides radiation dose to avoid these vulnerable regions while maintaining therapeutic efficacy. Integrating functional imaging into treatment planning allows for neuroprotective strategies in RT planning and potentially minimises the risk of cognitive impairment. This review sets the stage for future research to expand the benefit of functional imaging in glioma RT planning.
