Evaluation of the Dosimetric Feasibility of Hippocampal Sparing Intensity-Modulated Radiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma

Hân, Gia; Liu, Dong; Gan, Hua; Denniston, Kyle A.; Li, Sicong; Tan, Wenyong; Hu, Desheng; Zhen, Weining; Wang, Zhaohua

doi:10.1371/journal.pone.0090007

Cited by 21 publications

(20 citation statements)

References 25 publications

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“…These biological macromolecules can be detected in the peripheral blood. Thus, serum EA-IgA and VCA-IgA expression could be detected clinically to evaluate nasopharyngeal carcinoma lesions level [ 13 – 15 ]. In this study, we tested the 2 index expression levels mentioned above in human serum to investigate its correlation with clinical nasopharyngeal carcinoma staging and provide basis for early clinical staging diagnosis of nasopharyngeal carcinoma in the future.…”

Section: Discussionmentioning

confidence: 99%

Correlation Analysis of Nasopharyngeal Carcinoma TNM Staging with Serum EA IgA and VCA IgA in EBV and VEGF-C and -D

Sun

Wang

2015

Med Sci Monit

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BackgroundNasopharyngeal carcinoma often occurs in humans in the nasopharyngeal epithelium area. Ebstein-Barr (EB) virus plays a key role in the process of nasopharyngeal carcinoma lesions. Early antigen antibody (EA-IgA) and viral capsid antigen IgA (VCA-IgA) of EB virus detection in serum can effectively monitor the process of nasopharyngeal carcinoma lesions. Serum vascular endothelial growth factor (VEGF) -C and VEGF-D expression detection can reflect the distant metastases ability of human tumor cells.Material/Methods153 cases of nasopharyngeal carcinoma patients in our hospital were enrolled, while 148 cases of healthy adults were selected as control. ELISA was used to detect serum EA-IgA, VCA-IgA, VEGF-C and -D expression levels. Spearman rank correlation analysis was applied to test the correlation of nasopharyngeal carcinoma TNM clinical stage and different indexes.ResultsSerum EA-IgA, VCA-IgA, VEGF-C and -D expression in nasopharyngeal carcinoma patients was 43.74±2.6 U·mL−1, 62.5±2.7 U·mL−1, 473.25±3.4 pg·mL−1, and 498.36±2.3 pg·mL−1, respectively, which was significantly higher than in the control group as 18.65±3.7 U·mL−1, 23.74±1.5 U·mL−1, 225.42±2.3 pg·mL−1, and 257.24±3.5 pg·mL−1 (P<0.05). Nasopharyngeal carcinoma TNM clinical staging was obviously correlated with serum EA-IgA, VCA-IgA, and VEGF-C (P<0.05), but not VEGF-D (P>0.05).ConclusionsNasopharyngeal carcinoma patient serum EA-IgA and VCA-IgA expression levels were significantly correlated with TNM staging. The high levels of these 3 indicators suggest advanced nasopharyngeal carcinoma TNM staging and serious lesions.

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Section: Discussionmentioning

confidence: 99%

Correlation Analysis of Nasopharyngeal Carcinoma TNM Staging with Serum EA IgA and VCA IgA in EBV and VEGF-C and -D

Sun

Wang

2015

Med Sci Monit

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“…Additionally, not little evidence suggests that impaired hippocampal neurogenesis resulting from cranial irradiation [ 10 – 13 ] should be strongly associated with NCF impairment [ 9 , 14 ]. Moreover, a few studies demonstrated that the isodose distribution irradiating the hippocampus is definitely related to NCFs after cranial irradiation in patients with primary brain tumors [ 15 – 17 ] or in those with nasopharyngeal carcinoma [ 18 , 19 ]. As a result, it has been hypothesized that conformal hippocampal sparing during the course of WBRT (HS-WBRT) would provide meaningful preservation in terms of cognitive function [ 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

Hippocampal dosimetry correlates with the change in neurocognitive function after hippocampal sparing during whole brain radiotherapy: a prospective study

et al. 2015

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BackgroundWhole brain radiotherapy (WBRT) has been the treatment of choice for patients with brain metastases. However, change/decline of neurocognitive functions (NCFs) resulting from impaired hippocampal neurogenesis might occur after WBRT. It is reported that conformal hippocampal sparing would provide the preservation of NCFs. Our study aims to investigate the hippocampal dosimetry and to demonstrate the correlation between hippocampal dosimetry and neurocognitive outcomes in patients receiving hippocampal sparing during WBRT (HS-WBRT).MethodsForty prospectively recruited cancer patients underwent HS-WBRT for therapeutic or prophylactic purposes. Before receiving HS-WBRT, all participants received a battery of baseline neurocognitive assessment, including memory, executive functions and psychomotor speed. The follow-up neurocognitive assessment at 4 months after HS-WBRT was also performed. For the delivery of HS-WBRT, Volumetric Modulated Arc Therapy (VMAT) with two full arcs and two non-coplanar partial arcs was employed. For each treatment planning, dose volume histograms were generated for left hippocampus, right hippocampus, and the composite hippocampal structure respectively. Biologically equivalent doses in 2-Gy fractions (EQD2) assuming an alpha/beta ratio of 2 Gy were computed. To perform analyses addressing the correlation between hippocampal dosimetry and the change in scores of NCFs, pre- and post-HS-WBRT neurocognitive assessments were available in 24 patients in this study.ResultsScores of NCFs were quite stable before and after HS-WBRT in terms of hippocampus-dependent memory. Regarding verbal memory, the corresponding EQD2 values of 0, 10, 50, 80 % irradiating the composite hippocampal structure with <12.60 Gy, <8.81, <7.45 Gy and <5.83 Gy respectively were significantly associated with neurocognitive preservation indicated by the immediate recall of Word List Test of Wechsler Memory Scale-III. According to logistic regression analyses, it was noted that dosimetric parameters specific to left sided hippocampus exerted an influence on immediate recall of verbal memory (adjusted odds ratio, 4.08; p-value, 0.042, predicting patients’ neurocognitive decline after receiving HS-WBRT).ConclusionsFunctional preservation by hippocampal sparing during WBRT is indeed achieved in our study. Providing that modern VMAT techniques can reduce the dose irradiating bilateral hippocampi below dosimetric threshold, patients should be recruited in prospective trials of hippocampal sparing during cranial irradiation to accomplish neurocognitive preservation while maintaining intracranial control.Trial registrationCurrent Controlled Trials NCT02504788Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0562-x) contains supplementary material, which is available to authorized users.

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“…The mean dose was also considered as a parameter that should be considered for developing hippocampal‐sparing strategies in patients undergoing WBRT followed by radio‐surgical boost or WBRT and simultaneous integrated boost treated with VMAT. Hippocampal avoidance strategies have been also implemented for locally advanced nasopharyngeal carcinoma and in radiosurgery of multiple intracranial targets using Gamma Knife Perfection ® equipment . Both studies confirm the reduction in mean hippocampal dose up to 35% in hippocampal‐sparing replanned cases, maintaining the same conformity and target coverage.…”

Section: Discussionmentioning

confidence: 99%

“…Hippocampal injuries play a fundamental role both in short and long‐term memory loss and cognitive impairment . Cranial irradiation can induce hippocampus damage, as suggested by some studies . In particular, cognitive impairment caused by whole brain irradiation (WBRT) has been investigated .…”

Section: Introductionmentioning

confidence: 99%

Hippocampal sparing approach in fractionated stereotactic brain VMAT radio therapy: A retrospective feasibility analysis

Falco

Giancaterino

D’Andrea

et al. 2017

J Applied Clin Med Phys

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Volumetric Modulated Arc Therapy (VMAT) techniques for fractioned stereotactic brain radiotherapy (FSBRT) can achieve highly conformal dose distribution to intracranial lesions. However, they can potentially increase the dose to hippocampus (H) causing neurocognitive toxicity during the first four months after irradiation. The purpose of this study was to assess the feasibility of hippocampal‐sparing (HS) treatment plans in 22 patients with brain metastasis treated with VMAT technique. Firstly, we retrospectively analyzed hippocampal doses in all 22 VMAT original (not hippocampal‐sparing, NHS) plans. Plans with hippocampal dose exceeding constraints (9 out of 22) were re‐planned considering dose constraints on the hippocampus (H) and on hippocampal avoidance zone (HAZ) generated using 5 mm isotropic margin to the hippocampus. Conformity (CI) and homogeneity indexes (HI) on the target and MUs, were maintained as close as possible to the original plans. Mean CINHS and CIHS obtained were: 0.79 ± 0.11 and 0.81 ± 0.10, respectively (P = 0.75); mean HINHS and HIHS were 1.05 ± 0.02 and 1.04 ± 0.01 respectively (P = 0.72). In both sets of plans, the mean MU values were similar: 1033 ± 275 and 1022 ± 234 for NHS and HS respectively. In HS plans, the mean hippocampal dose was decreased by an average of 35%. After replanning, the Dmax (21.3 Gy) for HAZ and H was met by 45% (4/9) and 78% (7/9) of the NHS plans, respectively. The worst results were obtained for cases with target volumes extention closer than 12 mm to H, because of the difficulty to spare hippocampus without compromising target coverage. After replanning D40% constraint value (7.3 Gy) was met by all the 9 NHS plans. In conclusion, this study suggests that an hippocampal‐sparing approach to FSBRT is feasible resulting in a decrease in the dose to the hippocampus without any loss in conformity or increase in treatment time.

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Evaluation of the Dosimetric Feasibility of Hippocampal Sparing Intensity-Modulated Radiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma

Cited by 21 publications

References 25 publications

Correlation Analysis of Nasopharyngeal Carcinoma TNM Staging with Serum EA IgA and VCA IgA in EBV and VEGF-C and -D

Correlation Analysis of Nasopharyngeal Carcinoma TNM Staging with Serum EA IgA and VCA IgA in EBV and VEGF-C and -D

Hippocampal dosimetry correlates with the change in neurocognitive function after hippocampal sparing during whole brain radiotherapy: a prospective study

Hippocampal sparing approach in fractionated stereotactic brain VMAT radio therapy: A retrospective feasibility analysis

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