{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T03:45:25Z","timestamp":1792986325263,"version":"4.5.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,8,10]],"date-time":"2024-08-10T00:00:00Z","timestamp":1723248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017268","name":"Berlin Institute of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017268","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["5R38-CA245204"],"award-info":[{"award-number":["5R38-CA245204"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Central nervous system (CNS) injury following brain-directed radiotherapy remains a major challenge. Proton radiotherapy (PRT) minimizes radiation to healthy brain, potentially limiting sequelae. We characterized CNS radiotoxicity, including radiation-induced leukoencephalopathy (RIL), brain tissue necrosis (TN), and cerebral microbleeds (CMB), in glioma patients treated with PRT or photons (XRT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and Methods<\/jats:title>\n                  <jats:p>Thirty-four patients (19 male; median age 39.6 years) with WHO grade 2-3 gliomas treated with partial cranial radiotherapy (XRT [n\u2005=\u200517] vs PRT[n\u2005=\u200517]) were identified and matched by demographic\/clinical criteria. Radiotoxicity was assessed longitudinally for 3 years post-radiotherapy via serial analysis of T2\/FLAIR- (for RIL), contrast-enhanced T1- (for TN), and susceptibility (for CMB)-weighted MRI sequences. RIL was rated at whole-brain and hemispheric levels using a novel Fazekas scale-informed scoring system.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The scoring system proved reliable (ICC\u2005&amp;gt;\u20050.85). Both groups developed moderate-to-severe RIL (62%[XRT]; 71%[PRT]) within 3 years; however, XRT was associated with persistent RIL increases in the contralesional hemisphere, whereas contralesional hemispheric RIL plateaued with PRT at 1-year post-radiotherapy (t\u2005=\u20052.180; P\u2005=\u2005.037). TN rates were greater with PRT (6%[XRT] vs 18%[PRT]; P\u2005=\u2005ns). CMB prevalence (76%[XRT]; 71%[PRT]) and burden (mean #CMB: 4.0[XRT]; 4.2[PRT]) were similar; however, XRT correlated with greater contralesional hemispheric CMB burden (27%[XRT]; 17%[PRT]; X2\u2005=\u20054.986; P\u2005=\u2005.026), whereas PRT-specific CMB clustered at the radiation field margin (X2\u2005=\u200514.7; P\u2005=\u2005.002).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CNS radiotoxicity is common and progressive in glioma patients. Injury patterns suggest radiation modality-specificity as RIL, TN, and CMB exhibit unique spatiotemporal differences following XRT vs PRT, likely reflecting underlying dosimetric and radiobiological differences. Familiarity with such injury patterns is essential to improve patient management. Prospective studies are needed to validate these findings and assess their impacts on neurocognitive function.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyae195","type":"journal-article","created":{"date-parts":[[2024,8,10]],"date-time":"2024-08-10T17:10:10Z","timestamp":1723309810000},"page":"e1748-e1761","source":"Crossref","is-referenced-by-count":17,"title":["Unique brain injury patterns after proton vs photon radiotherapy for WHO grade 2-3 gliomas"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8836-0235","authenticated-orcid":false,"given":"Sebastian F","family":"Winter","sequence":"first","affiliation":[{"name":"Division of Neuro-Oncology, Mass General Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 ,","place":["United States"]},{"name":"Department of Neurology with Experimental Neurology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin ,","place":["Germany"]},{"name":"Berlin Institute of Health at Charite\u0301 \u2013 Universita\u0308tsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charite\u0301 Junior Clinician Scientist Program , 10117 Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M","family":"Gardner","sequence":"additional","affiliation":[{"name":"Division of Neuro-Oncology, Mass General Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 ,","place":["United States"]},{"name":"Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA 02114 ,","place":["United 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