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Clin Transl Radiat Oncol. 2017 Nov 23;8:22-26. doi: 10.1016/j.ctro.2017.11.010. eCollection 2018 Jan.

The posterior cerebellum, a new organ at risk?

Eekers DBP1,2,1,3,4,5,1,6,7,6,7,1,8,9,10,11,12, In 't Ven L1,3,4,5,1,6,7,6,7,1,8,9,10,11,12, Deprez S3,4,5,1,6,7,6,7,1,8,9,10,11,12, Jacobi L5,1,6,7,6,7,1,8,9,10,11,12, Roelofs E1,6,7,6,7,1,8,9,10,11,12, Hoeben A7,6,7,1,8,9,10,11,12, Lambin P6,7,1,8,9,10,11,12, de Ruysscher D1,8,9,10,11,12, Troost EGC9,10,11,12.

Author information

1
Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
2
Proton Therapy Department South-East Netherlands (ZON-PTC), Maastricht, The Netherlands.
3
Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
4
Department of Radiology, University Hospital Leuven, Leuven, Belgium.
5
Dept. of Radiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
6
The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht Comprehensive Cancer Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
7
Dept of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
8
KU Leuven, Radiation Oncology University Hospitals Leuven, Department of Radiation Oncology/KU Leuven, Radiation Oncology, Leuven, Belgium.
9
Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universit├Ąt Dresden, Dresden, Germany.
10
Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.
11
OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.
12
German Cancer Consortium (DKTK), Partnersite Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.

Abstract

Eekers et al. have recently proposed a neuro-oncology atlas, which was co-authored by most centers associated in the European Proton Therapy Network (EPTN; Figure 1). With the introduction of new treatment techniques, such as integrated magnetic resonance imaging and linear accelerators (MR-linac) or particle therapy, the prediction of clinical efficacy of these more costly treatment modalities becomes more relevant. One of the side-effects of brain irradiation, being cognitive decline, is one of the toxicities most difficult to measure and predict. In order to validly compare different treatment modalities, 1) a uniform nomenclature of the organs at risk (OARs), 2) uniform atlas-based delineation [e.g., Eekers et al.], 3) long-term follow-up data with standardized cognitive tests, 4) a large patient population, and 5) (thus derived) validated normal tissue complication probability (NTCP) models are mandatory. Apart from the Gondi model, in which the role of the dose to 40% of both hippocampi (HC) proves to be significantly related to cognition in 18 patients, no similar models are available. So there is a strong need for more NTCP models, on HC, brain tissue and possible other relevant brain structures. In this review we summarize the available evidence on the role of the posterior cerebellum as a possible new organ at risk for cognition, which is deemed relevant for irradiation of brain and head and neck tumors.

KEYWORDS:

Cognition; Delineation atlas; Neuro-oncology; Organ at risk; Posterior cerebellum; Radiotherapy

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