Intracranial failure after hippocampal-avoidance prophylactic cranial irradiation in limited-stage small-cell lung cancer patients

Cho, Yeona; Lee, Joongyo; Lee, Ik Jae; Kim, Jun Won; Baek, Ju Yuel; Jung, Dong Min; Cho, Byoung Chul; Hong, Min Hee; Kim, Hye Ryun; Lee, Chang Geol; Yoon, Hong In

doi:10.1038/s41598-021-86851-6

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…Following these prospective clinical trials to confer neuro-cognitive protection in metastatic brain disease, HA-WBRT has gained clinical acceptance (7,8). However, perihippocampal failure has been reported from clinical observations (18)(19)(20). We have also reported unusual cases of intracranial failure following HA-WBRT therapy and perihippocampal failure rate was about 8% in…”

Section: Discussionmentioning

confidence: 91%

Retrospective analysis of dosimetry on hippocampal-avoidance whole-brain radiotherapy in a regional hospital

Yen¹,

Shieh²,

Lee³

et al. 2023

Ther Radiol Oncol

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Background: Hippocampal-avoidance whole-brain radiotherapy presents a significant technical challenge in terms of treatment planning in order to spare the hippocampus. To ensure dose homogeneity and precision, the Radiation Therapy Oncology Group (RTOG) 0933 recommends strict dose criteria. To balance the clinical workload with these time-consuming treatments is a challenge. Noncompliance adversely might affect clinical outcomes in cancer patients with brain metastasis. We intend to retrospectively evaluate the quality and dosimetry differences in delivering hippocampal-avoidance whole-brain radiotherapy in a regional hospital.Methods: We retrospectively analyzed cancer patients with brain metastases who were diagnosed between January 2014 and December 2020. Dosimetry parameters were compared in terms of deviation from the RTOG 0933 protocol. Results:We identified 21 eligible cancer patients with brain metastasis who underwent hippocampalavoidance whole-brain radiotherapy. The patients' ages ranged from 36 to 81 years (median, 58 years).Sixteen patients (76%) received linear accelerator-based treatment, while five received TomoTherapy. The maximal dose to bilateral hippocampi ranged from 9.2 to 25.8 Gy, with a median of 14.4 Gy. In our crossmodality analysis of the planning target volume (PTV) coverage, linear accelerator planning was comparable to TomoTherapy (P=0.29), and both treatments met the RTOG 0933 criteria in (D 2% ≤37.5 Gy) hotspot evaluation. TomoTherapy was statistically superior to linear accelerator in the minimum PTV dose criteria (D 98% >25 Gy) (P=0.03). Regarding the constraint dose of hippocampi, TomoTherapy tend to outperform linear accelerator treatment (P=0.1). The TomoTherapy technique had the longest delivery time (median: 437 sec), compared to 364 sec for the linear accelerator, with statistical significance (P=0.03). Conclusions:In this study, we presented a dosimetry analysis of hippocampal-avoidance whole-brain radiotherapy in clinical settings. The dilemma does exist in balancing clinical workload with the timeconsuming planning, so daily treatment may come at the expense of noncompliance and non-conformity on planning targets. In determining the final plan, the choice of the physician should depend on patient's clinical situation and institutional facility.

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Section: Discussionmentioning

confidence: 91%

Retrospective analysis of dosimetry on hippocampal-avoidance whole-brain radiotherapy in a regional hospital

Yen¹,

Shieh²,

Lee³

et al. 2023

Ther Radiol Oncol

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“…The landmark NRG Oncology CC003 study conducted in the United States reported an intracranial relapse rate of 14.2% at 12 months (18), while an investigation conducted in South Korea reported a relapse rate of 20.8% (19). However, the rate of intracranial failure in that study did not differ significantly between conventional PCI and HA-PCI groups, and no clinical factor was found to be associated with the intracranial failure (19). In our study, the bilateral hippocampal volumes following HA-PCI did not decrease significantly.…”

Section: Discussionmentioning

confidence: 99%

Hippocampal Avoidance Prophylactic Cranial Irradiation using Helical Tomotherapy in Small Cell Lung Cancer

Jia-Mahasap,

Vuthiwong,

Klunklin

et al. 2024

BSCM

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OBJECTIVE Prophylactic cranial irradiation (PCI) is a standard treatment for small cell lung cancer (SCLC). Reduced radiation doses at the hippocampal region during PCI might protect against neurocognitive decline after radiotherapy (RT). The purpose of this study is to report the outcome of hippocampal avoidance PCI (HA-PCI) in our center. METHODS After the initial treatment of SCLC, patients whose radiographic data confirmed the absence of intracranial metastasis and controlled of the primary disease received HA-PCI. Thai Mental State Examination (TMSE) and bilateral hippocampal volumes were recorded and analyzed using the Wilcoxon Singed Rank test to compare baseline and two time points (3 and 6 months). The two-year overall survival (OS) and brain control rates were estimated using the Kaplan Meier method. RESULTS Between 2018 and 2021, a total of 10 patients were included in the analysis. The median TMSE and bilateral hippocampal volumes showed no statistically significant difference between baseline and 3 and 6 months. Two-year OS and brain control rates were 78.8% and 71.4%, respectively. Three patients developed intracranial relapses after HA-PCI which were located outside the hippocampal region. CONCLUSIONS HA-PCI did not increase intracranial relapse in this study. HA-PCI should be considered as a treatment option which can potentially protect neurocognitive functions.

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“…Cho et al reported 48 patients with SCLC who underwent HA-PCI; 2 developed perihippocampal recurrence. It was suggested that HA-PCI may be associated with an increased risk of intracranial failure, whereas HA-PCI did not impair disease control or survival [20] . Redmond et al reported 20 patients with SCLC who received HA-PCI; 2 patients developed metastases in the under-dosed region, 1 on the dentate gyrus and 1 around the HA region [27] .…”

Section: Discussionmentioning

confidence: 99%

“…It was suggested that HA-PCI may be associated with an increased risk of intracranial failure, whereas HA-PCI did not impair disease control or survival. [ 20 ] Redmond et al reported 20 patients with SCLC who received HA-PCI; 2 patients developed metastases in the under-dosed region, 1 on the dentate gyrus and 1 around the HA region. [ 27 ] A phase 3 randomized trial of PCI with or without HA in SCLC concluded no difference was observed between the arms in the incidence of brain metastasis or in overall survival rates, neither in patients with stages I to III or stage IV disease.…”

Section: Discussionmentioning

confidence: 99%

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Perihippocampal failure after hippocampal-avoidance whole-brain radiotherapy in cancer patients with brain metastases

et al. 2022

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Perihippocampal failure is a rare clinical scenario in brain metastatic cancer patients following hippocampal-avoidance (HA) whole-brain radiotherapy (HA-WBRT). The clinical features have not been fully identified because clinical data on intracranial failure after HA-WBRT are limited. It is thus necessary to accumulate clinical data.We retrospectively analyzed cancer patients with brain metastases who were diagnosed between January 2014 and September 2020 at a regional referral hospital. The medical records of patients who underwent HA-WBRT were reviewed. The clinical features of intracranial recurrence were described. Dosimetry parameters were compared in terms of deviation from the recommended protocol of the Radiation Therapy Oncology Report 0933.Twenty-four eligible patients with brain metastases who underwent HA-WBRT were identified; 13 (54%) were male. Seventeen patients (71%) had lung cancer, 6 (25%) had breast cancer, and 1 (4%) had liver cancer. The median overall survival was 12 months. Three patients developed intracranial failure during clinical follow-up, and 2 relapsed with intracranial failure in the perihippocampal region at 13 and 22 months, respectively. The perihippocampal failure rate was about 8%. One patient with small cell lung cancer received HA-prophylactic cranial irradiation; the minimum and maximum doses to the hippocampi were 6.8 and 10.7 Gy, respectively. Another patient with brain metastases from lung adenocarcinoma received HA-WBRT; the minimum and maximum doses to the hippocampi were 5.4 and 10.6 Gy, respectively.We reported unusual cases of intracranial failure in the perihippocampal region following HA-WBRT. Perihippocampal failure could be attributed to an under-dose of radiation partially or be resulted from aggressiveness of cancer per se. Further research on this topic is encouraged.

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Intracranial failure after hippocampal-avoidance prophylactic cranial irradiation in limited-stage small-cell lung cancer patients

Cited by 7 publications

References 24 publications

Retrospective analysis of dosimetry on hippocampal-avoidance whole-brain radiotherapy in a regional hospital

Retrospective analysis of dosimetry on hippocampal-avoidance whole-brain radiotherapy in a regional hospital

Hippocampal Avoidance Prophylactic Cranial Irradiation using Helical Tomotherapy in Small Cell Lung Cancer

Perihippocampal failure after hippocampal-avoidance whole-brain radiotherapy in cancer patients with brain metastases

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