PURPOSE: The purpose of this study was to determine radiation dose effect on the structural integrity of cerebral white matter in @entity976 @entity1 receiving surgery and proton therapy. METHODS AND MATERIALS: Fifty-one @entity1 (2.1-19.3 years of age) with @entity976 underwent surgery and proton therapy in a prospective therapeutic trial. Anatomical magnetic resonance images acquired after surgery but before proton therapy were inspected to identify white matter structures intersected by surgical corridors and catheter tracks. Longitudinal diffusion tensor imaging (DTI) was performed to measure microstructural integrity changes in cerebral white matter. Fractional anisotropy (FA) derived from DTI was statistically analyzed for 51 atlas-based white matter structures of the brain to determine radiation dose effect. FA in surgery-affected regions in the corpus callosum was compared to that in its intact counterpart to determine whether @entity154 affect radiation dose effect. RESULTS: @entity154 were seen most frequently in the corpus callosum because of transcallosal resection of @entity5 and insertion of ventricular or cyst catheters. Longitudinal DTI data indicated reductions in FA 3 months after therapy, which was followed by a recovery in most white matter structures. A greater FA reduction was correlated with a higher radiation dose in 20 white matter structures, indicating a radiation dose effect. The average FA in the surgery-affected regions before proton therapy was smaller (P=.0001) than that in their non-surgery-affected counterparts with more intensified subsequent reduction of FA (P=.0083) after therapy, suggesting that surgery accentuated the radiation dose effect. CONCLUSIONS: DTI data suggest that mild radiation dose effects occur in @entity1 with @entity976 receiving surgery and proton therapy. @entity154 present at the time of proton therapy appear to accentuate the radiation dose effect longitudinally. This study supports consideration of pre-existing @entity154 and their locations in proton therapy planning and studies of treatment effect.

Effects of Surgery and Proton Therapy on Cerebral White Matter of @entity976 XXXX .

@entity976 :: ('MESH:D003397', 'Disease') :: ['craniopharyngioma'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity154 :: ('MESH:D000013', 'Disease') :: ['surgical defects', 'Surgical defects'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumors']
@entity1 :: (9606,Species) :: ['Patients']
