Radiation and brain structure: minimising deficits in paediatric brain tumour survivors

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1. The overall survival rate of children with brain tumours has increased dramatically due to the availability of various treatment strategies such as surgery and radiotherapy. However, these improvements in survival are accompanied by serious brain impairments. For example, deficits in attention, memory, ability to switch between tasks, speed of processing and literacy are commonly seen in survivors. To better understand how these impairments arise, imaging techniques have been used to investigate damage to structure of the brain as a result of irradiation. Magnetic resonance imaging (MRI) allows us to take pictures of the brain. Using a special technique called diffusion MRI it is possible to measure the degree of damage to the brain structure and to map this spatially.2. This project seeks to map brain microstructural damage in cancer survivors and to determine how this damage relates to various post-treatment brain deficits. There is a specific opportunity to match radiotherapy treatment fields to imaging data to better understand the relationship between radiation dose, microstructural brain damage and cognitive and behavioural deficits. With the emergence of proton therapy it is also timely to better understand these relationships given that early evidence suggests improved cognitive outcomes in proton versus photon radiotherapy. Better understanding of these relationships opens the opportunity to modify the radiotherapy treatment fields to spare vital brain regions and reduce the frequency and severity with which post-treatment brain problems occur in the future.3. The co-registration of diffusion MRI, which is able to measure the degree of damage to the brain structure and to map this spatially, with point by point dose from the dose distribution cube in a radiotherapy treatment planning system will allow assessment of various microstructural parameters derived from multi-shell diffusion MRI against the dose distribution to be derived for the first time.4. This work closely aligns with EPSRC strategies to optimise diagnosis and treatment by the development of innovative analytical techniques and novel imaging technologies to transform prediction and monitoring for health and with various EPSRC research areas including medical imaging and healthcare technologies5. This project brings together a multi-disciplinary team with experts in neuro-oncology, radiation oncologists, imaging physicists and neuro-psychologists working between University College London Hospital, Great Ormond Street Hospital for Children and the UCL Department of Medical Physics and Biomedical Engineering and UCL Great Ormond Street Institute of Child Health.