Chemotherapy and Radiation For Brain Cancer Lead To Brain Shrinkage

Jorg Dietrich, MBA MMSc MD PhD Director, Cancer & Neurotoxicity Clinic and Brain Repair Research Program Massachusetts General Hospital Cancer Center Assistant Professor of Neurology Harvard Medical Interview with:
Jorg Dietrich, MBA MMSc MD PhD 
Director, Cancer & Neurotoxicity Clinic and Brain Repair Research Program
Massachusetts General Hospital Cancer Center
Assistant Professor of Neurology
Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Dietrich: Understanding the adverse effects associated with cancer therapy is an important issue in oncology. Specifically, management of acute and delayed neurotoxicity of chemotherapy and radiation in brain cancer patients has been challenging. There is an unmet clinical need to better characterize the effects of standard cancer therapy on the normal brain and to identify patients at risk of developing neurotoxicity. In this regard, identifying novel biomarkers of neurotoxicity is essential to develop strategies to protect the brain and promote repair of treatment-induced damage.

In this study, we demonstrate that standard chemotherapy and radiation in patients treated for glioblastoma is associated with progressive brain volume loss and damage to gray matter – the area of the brain that contains most neurons.

A cohort of 14 patients underwent sequential magnetic resonance imaging studies prior to, during and following standard chemoradiation to characterize the pattern of structural changes that occur as a consequence of treatment.

Medical Research: What should clinicians and patients take away from your report?

Dr. Dietrich: The effects of chemotherapy and radiation on the brain remain poorly understood. With an increasing number of long-term survivors, it is increasingly important to better understand how cancer therapy affects the nervous system and to identify patients at highest risk to develop neurotoxic symptoms.

The findings from this study should not discourage the use of chemotherapy and radiation, as these remain the standard of care to fight brain cancer. In contrast, the results from this study should promote further investigations in this field to minimize the harmful effects of existing treatments on the brain.

Importantly, understanding the mechanisms of neurotoxicity will be the basis for development of more selective therapies designed to avoid harmful effects on normal tissues, and to improve quality of life of patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Dietrich: It remains unclear whether the structural changes that we have observed in our study are associated with neurocognitive symptoms, such as memory impairment. This is the subject of ongoing investigations. Future studies will have to demonstrate how structural changes in the brain are linked to functional outcomes, such as memory problems, cognitive impairment and mood changes.


Standard chemoradiation for glioblastoma results in progressive brain volume loss
Morgan J. Prust, MD, Kourosh Jafari-Khouzani, PhD, Jayashree Kalpathy-Cramer, PhD, Pavlina Polaskova, MD,Tracy T. Batchelor, MD, Elizabeth R. Gerstner, MD and  Jorg Dietrich, MD, PhD

Published online before print July 24, 2015,

doi: http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000001861
Neurology 10.1212/WNL.0000000000001861

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Jorg Dietrich, MBA MMSc MD PhD (2015). Chemotherapy and Radiation For Brain Cancer Lead To Brain Shrinkage