Left hippocampus sparing whole brain radiotherapy (WBRT): A planning study

Kazda, Tomáš; Vrzal, Miroslav; Procházka, Tomáš; Dvoracek, Petr; Burkoň, Petr; Pospíšil, Petr; Dziacky, Adam; Nikl, Tomas; Jančálek, Radim; Šlampa, Pavel; Lakomý, Radek

doi:10.5507/bp.2017.031

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…It has been shown that unilateral hippocampal avoidance during WBRT can also mitigate cognitive decline, formation of memory, verbal memory, similar to bilateral HA-WBRT [ 33 – 36 ]. Furthermore, meta-analysis of 33 studies, which evaluated memory before and after resection of left or right anterior temporal lobe for temporal lobe epilepsy has observed difference in verbal memory function after resection from the left or right temporal lobe [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance

et al. 2018

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BackgroundMelanoma brain metastases (MBM) often cause morbidity and mortality for stage IV melanoma patients. An ongoing randomised phase III trial (NCT01503827 – WBRT-Mel) evaluates the role of adjuvant whole brain radiotherapy (WBRT) following local treatment of MBM. Hippocampal avoidance during WBRT (HA-WBRT) has shown memory and neurocognitive function (NCF) preservation in the RTOG-0933 phase II study. This study assessed the quality assurance of HA-WBRT within the WBRT-Mel trial according to RTOG-0933 study criteria.MethodsHippocampal avoidance was allowed in approved centres with intensity-modulated radiotherapy capability. Patients treated by HA-WBRT were not randomized within the WBRT arm. The RTOG 0933 contouring Atlas was used to contour hippocampi. In the trial co-ordinating centre, patients were treated with volumetric modulated arc therapy using complementary arcs; similar techniques were used at other sites. Dosimetric data were extracted retrospectively and analysed in accordance with RTOG 0933 study constraints criteria.ResultsAmong the 215 patients accrued to the WBRT-Mel study between April 2009 and September 2017, 107 were randomized to the WBRT arm, 22 were treated by HA-WBRT in 4 centers. Eighteen patients were treated in the same centre. The median age was 65 years. The commonest (91%) HA-WBRT schema was 30 Gy in 10 fractions. Prior to HA-WBRT, 10 patients had been treated by surgery alone, six by radiosurgery alone, four by surgery and radiosurgery and two exclusively by simultaneous integrated boost concurrent to HA-WBRT. Twenty patients were treated with intention to spare both hippocampi and two patients had MBM close to one hippocampus and were treated with intention to spare the contralateral hippocampus. According to RTOG-0933 study criteria, 18 patients (82%) were treated within constraints and four patients (18%) had unacceptable deviation in just one hippocampus.ConclusionsThis dosimetric quality assurance study shows good compliance (82%) according to RTOG-0933 study dosimetric constraints. Indeed, all patients respected RTOG hippocampal avoidance constraints on at least one hippocampus. In the futureanalysis of the WBRT-Mel trial, the NCF of patients on the observation arm, WBRT arm and with HA-WBRT arm will be compared.

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Section: Discussionmentioning

confidence: 99%

Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance

et al. 2018

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“…With the hypothesized noninferiority of unilateral sparing, there would be a possible advantage of about 50% reduction in the risk of subsequent recurrence within spared regions based on our current observation of no significant difference in the laterality of BM seeding. Moreover, unilateral hippocampal avoiding leads to dosimetrically increased sparing of preserved hippocampus [21].…”

Section: Discussionmentioning

confidence: 99%

“…This novel approach of unilateral hippocampus sparing WBRT would be associated with reduced concern regarding subtherapeutic dose in spared regions and with the possibility of improved sparing of single hippocampus. In our pilot dosimetric study, left unilateral sparing yielded lower doses in spared hippocampus with a more homogenous irradiation of the remaining brain [21]. To justify clinical testing of this radiotherapy technique, it would be useful to evaluate whether there is some difference in the incidence of BM within left versus right hippocampus; however, no prior study has assessed the laterality of hippocampal BM seeding.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Hippocampal Metastases: Laterality and Implications for Unilateral Hippocampal Avoiding Whole Brain Radiotherapy

Kazda

Mišove

Burkoň

et al. 2018

BioMed Research International

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Introduction Hippocampi sparing whole brain radiotherapy (WBRT) is an evolving approach in the treatment of patients with multiple brain metastases, pursuing mitigation of verbal memory decline as a consequence of hippocampal radiation injury. Accumulating data are showing different postradiotherapy changes in the left and right hippocampus with a theoretical proposal of only unilateral (dominant, left) hippocampal sparing during WBRT. Method The aim of this retrospective study is to describe spatial distribution of brain metastases on MRI in a cohort of 260 patients (2595 metastases) and to evaluate distribution separately in the left and right hippocampus and in respective hippocampal avoiding zones (HAZ, region with subtherapeutic radiation dose), including evaluation of location of metastatic mass centre. Results The median number of brain metastases was three, with lung cancer being the most common type of primary tumour; 36% had single metastasis. Almost 8% of patients had metastasis within hippocampus (1.1% of all metastases) and 18.1% of patients within HAZ (3.3% of all metastases). No statistically significant difference was observed in the laterality of hippocampal involvement, also when the location of centre of metastases was analyzed. There were more patients presenting the centre of metastasis within left (15) versus right (6) HAZ approaching the borderline of statistical significance. Conclusion No significant difference in the laterality of BM seeding within hippocampal structures was observed. The hypothesized unilateral sparing WBRT would have theoretical advantage in about 50% reduction in the risk of subsequent recurrence within spared regions.

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“…Accurate and automatic hippocampus segmentation from magnetic resonance (MR) brain images is important in several neuroimaging studies of brain disorders, such as brain cancer, epilepsy, and Alzheimer’s disease (AD) 1–3 . To achieve fully automated hippocampus segmentation, atlas-based methods have been proposed for hippocampus segmentation 4 .…”

Section: Introductionmentioning

confidence: 99%

Multi-atlas label fusion with random local binary pattern features: Application to hippocampus segmentation

Zhu

Tang

Cheng

et al. 2019

Sci Rep

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Automatic and reliable segmentation of the hippocampus from magnetic resonance (MR) brain images is extremely important in a variety of neuroimage studies. To improve the hippocampus segmentation performance, a local binary pattern based feature extraction method is developed for machine learning based multi-atlas hippocampus segmentation. Under the framework of multi-atlas image segmentation (MAIS), a set of selected atlases are registered to images to be segmented using a non-linear image registration algorithm. The registered atlases are then used as training data to build linear regression models for segmenting the images based on the image features, referred to as random local binary pattern (RLBP), extracted using a novel image feature extraction method. The RLBP based MAIS algorithm has been validated for segmenting hippocampus based on a data set of 135 T1 MR images which are from the Alzheimer’s Disease Neuroimaging Initiative database (adni.loni.usc.edu). By using manual segmentation labels produced by experienced tracers as the standard of truth, six segmentation evaluation metrics were used to evaluate the image segmentation results by comparing automatic segmentation results with the manual segmentation labels. We further computed Cohen’s d effect size to investigate the sensitivity of each segmenting method in detecting volumetric differences of the hippocampus between different groups of subjects. The evaluation results showed that our method was competitive to state-of-the-art label fusion methods in terms of accuracy. Hippocampal volumetric analysis showed that the proposed RLBP method performed well in detecting the volumetric differences of the hippocampus between groups of Alzheimer’s disease patients, mild cognitive impairment subjects, and normal controls. These results have demonstrated that the RLBP based multi-atlas image segmentation method could facilitate efficient and accurate extraction of the hippocampus and may help predict Alzheimer’s disease. The codes of the proposed method is available (https://www.nitrc.org/frs/?group_id=1242).

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Left hippocampus sparing whole brain radiotherapy (WBRT): A planning study

Cited by 8 publications

References 27 publications

Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance

Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance

Incidence of Hippocampal Metastases: Laterality and Implications for Unilateral Hippocampal Avoiding Whole Brain Radiotherapy

Multi-atlas label fusion with random local binary pattern features: Application to hippocampus segmentation

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