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Martín-Tovar EA, Badillo-Alvarado AH, Cocom-Poot LE, Gaxiola-Sosa JL. Modulated Arc Therapy for hippocampal-avoidance whole brain radiation therapy: planning comparison with intensity modulated Radiation Therapy. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:443-454. [PMID: 38809486 DOI: 10.1007/s00411-024-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/25/2024] [Indexed: 05/30/2024]
Abstract
This study aimed to evaluate the modulated arc therapy (mARC) technique as a planning and treatment option for hippocampal sparing whole brain radiotherapy (HS-WBRT) following the Radiation Therapy Oncology Group (RTOG) 0933 dosimetric criteria. Computed tomography (CT) and magnetic resonance imaging (MRI) were selected retrospectively for 15 patients. Two types of plans were created for each patient, namely an intensity-modulated radiation therapy (IMRT) and a mARC plan. IMRT and mARC plans were compared in terms of plan quality indices, absorbed dose to organs at risk (OARs), number of monitor units (MUs), and treatment time. All plans in both techniques were considered clinically acceptable for treatment. However, IMRT plans presented a higher conformity (p = 0.01) as well as a higher homogeneity as compared to mARC plans, but this difference was not statistically significant (p > 0.05). In terms of the preservation of the hippocampus, it was observed that the IMRT plans achieved significantly lower doses for both 100% of its volume and for its maximum dose (p < 0.001). The evaluation of the remaining OARs showed that the IMRT technique resulted in lower doses, and significant differences were observed for the following organs: left cochlea (p < 0.001), left eye (p < 0.001), right eye (p = 0.03), both lenses of the eye (p < 0.001), and right optic nerve (p = 0.02). Despite these differences, the absolute differences in all dosimetric parameters were low enough to bear any clinical relevance. A drastic (close to 65%) and significant (p < 0.001) decrease was observed in the number of MUs for the mARC plans. This resulted in a substantial decrease in treatment time (60.45%, p < 0.001). It is concluded that the mARC technique is a feasible planning and treatment solution for HS-WBRT that meets the RTOG 0933 criteria. The main advantage of using mARC over IMRT for HS-WBRT is the considerable reduction in MUs and treatment time.
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Affiliation(s)
- E A Martín-Tovar
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, Mérida Yucatán, CP 97150, México.
| | - A H Badillo-Alvarado
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, Mérida Yucatán, CP 97150, México
| | - L E Cocom-Poot
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, Mérida Yucatán, CP 97150, México
| | - J L Gaxiola-Sosa
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, Mérida Yucatán, CP 97150, México
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Wiegreffe S, Sarria GR, Layer JP, Dejonckheere E, Nour Y, Schmeel FC, Anton Giordano F, Schmeel LC, Popp I, Grosu AL, Gkika E, Stefaan Dejonckheere C. Incidence of hippocampal and perihippocampal brain metastases and impact on hippocampal-avoiding radiotherapy: A systematic review and meta-analysis. Radiother Oncol 2024; 197:110331. [PMID: 38772476 DOI: 10.1016/j.radonc.2024.110331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND AND PURPOSE In patients requiring prophylactic cranial irradiation (PCI) or whole-brain radiotherapy (WBRT) for brain metastases (BMs), hippocampal avoidance (HA) has been shown to preserve neurocognitive function and quality of life. Here, we aim to estimate the incidence of hippocampal and perihippocampal BMs and the subsequent risk of local undertreatment in patients undergoing hippocampal sparing radiotherapy. MATERIALS AND METHODS MEDLINE, Embase, and Scopus were searched with the terms "Hippocampus", "Brain Neoplasms", and related terms. Trials reporting on the incidence of hippocampal and/or perihippocampal BMs or hippocampal failure rate after PCI or WBRT were included. RESULTS Forty records were included, encompassing a total of 5,374 patients with over 32,570 BMs. Most trials employed a 5 mm margin to define the HA zone. In trials reporting on BM incidence, 4.4 % (range 0 - 27 %) and 9.2 % (3 - 41 %) of patients had hippocampal and perihippocampal BMs, respectively. The most common risk factor for hippocampal BMs was the total number of BMs. The reported failure rate within the HA zone after HA-PCI or HA-WBRT was 4.5 % (0 - 13 %), salvageable with radiosurgery in most cases. SCLC histology was not associated with a higher risk of hippocampal failure (OR = 2.49; p = 0.23). In trials comparing with a conventional (non-HA) PCI or WBRT group, HA did not increase the hippocampal failure rate (OR = 1.90; p = 0.17). CONCLUSION The overall incidence of hippocampal and perihippocampal BMs is considerably low, with a subsequent low risk of local undertreatment following HA-PCI or HA-WBRT. In patients without involvement, the hippocampus should be spared to preserve neurocognitive function and quality of life.
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Affiliation(s)
- Shari Wiegreffe
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; Institute of Experimental Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioural Sciences, 5037 Tilburg, the Netherlands
| | - Younèss Nour
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Frank Anton Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, 68167 Mannheim, Germany; DKFZ-Hector Cancer Institute, University Medical Center Mannheim, 68167 Mannheim, Germany
| | | | - Ilinca Popp
- Department of Radiation Oncology, Medical Faculty, University Freiburg, 79106 Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Faculty, University Freiburg, 79106 Freiburg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
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Tang L, Tian G, Li N. Current dilemma and future directions over prophylactic cranial irradiation in SCLC: a systematic review in MRI and immunotherapy era. Front Oncol 2024; 14:1382220. [PMID: 39139283 PMCID: PMC11319250 DOI: 10.3389/fonc.2024.1382220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Small cell lung cancer (SCLC) is the most malignant pathological type of lung cancer with the highest mortality, and the incidence of brain metastasis (BM) is in high frequency. So far, prophylactic cranial irradiation (PCI) has been suggested as an effective treatment for preventing brain metastasis of SCLC. PCI has long been applied to limited-stage SCLC (LS-SCLC) patients who have achieved complete remission after radiotherapy and chemotherapy as a standard treatment. However, the neurocognitive decline is a major concern surrounding PCI. New therapeutic approaches targeting PCI-induced neurotoxicity, including hippocampal protection or memantine, have been increasingly incorporated into the therapeutic interventions of PCI. Helical tomotherapy, RapidArc, and Volumetric-modulated arc therapy (VMAT) with a head-tilting baseplate are recommended for hippocampal protection. Besides, in the MRI and immunotherapy era, the significance of PCI in SCLC patients is controversial. SCLC patients with PCI should be recruited in clinical trials since this is the only way to improve the existing standard of care. This review summarizes the current therapeutic strategy and dilemma over PCI for SCLC, providing a theoretical basis for clinical decision-making and suggestions for PCI practice in clinical.
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Affiliation(s)
| | | | - Nan Li
- Department of Radiation Oncology, the First Hospital of China Medical University, Shenyang, China
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Li Z, Wang J, Deng L, Zhai Y, Zhang T, Bi N, Wang J, Wang X, Liu W, Xiao Z, Chen D, Lv J, Feng Q, Wang W, Zhou Z. Hippocampal avoidance whole-brain radiotherapy with simultaneous integrated boost in lung cancer brain metastases and utility of the Hopkins verbal learning test for testing cognitive impairment in Chinese patients: a prospective phase II study. BMC Cancer 2024; 24:899. [PMID: 39060968 PMCID: PMC11282618 DOI: 10.1186/s12885-024-12559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the efficiency of hippocampal avoidance whole-brain radiotherapy with a simultaneous integrated boost (HA-WBRT-SIB) treating brain metastases (BM) and utility of the Hopkins Verbal Learning Test-Revised (HVLT-R) (Chinese version) in Chinese lung cancer patients. METHODS Lung cancer patients with BM undergone HA-WBRT-SIB at our center were enrolled. Brain magnetic resonance imaging, The HVLT total learning score, and side effects were evaluated before radiotherapy and 1, 3, 6, and 12 months after radiotherapy. This study analyzed the overall survival rate, progression-free survival rate, and changes in HVLT-R immediate recall scores. RESULTS Forty patients were enrolled between Jan 2016 and Jan 2020. The median follow-up time was 14.2 months. The median survival, progression-free survival, and intracranial progression-free survival of all patients were 14.8 months, 6.7 months and 14.8 months, respectively. Multivariate analysis indicated that male sex and newly diagnosed stage IV disease were associated with poor overall survival and progression-free survival, respectively. HVLT-R scores at baseline and 1, 3, and 6 months after radiotherapy were 21.94 ± 2.99, 20.88 ± 3.12, 20.03 ± 3.14, and 19.78 ± 2.98, respectively. The HVLT-R scores at 6 months after radiotherapy decreased by approximately 9.8% compared with those at baseline. No grade 3 toxicities occurred in the entire cohort. CONCLUSIONS HA-WBRT-SIB is of efficiency and cognitive-conserving in treating Chinese lung cancer BM. TRIAL REGISTRATION This study was retrospectively registered on ClinicalTrials.gov in 24th Feb, 2024. The ClinicalTrials.gov ID is NCT06289023.
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Affiliation(s)
- Zhuoran Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China.
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, P.R. China.
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Giakoumettis G, Gkantaifi A, Giakoumettis D, Papanastasiou E, Plataniotis G, Misailidou D, Kouskouras K, Bamidis PD, Siountas A. Sparing the Hippocampus in Prophylactic Cranial Irradiation Using Three Different Linear Accelerators: A Comparative Study. Cureus 2024; 16:e63137. [PMID: 39055412 PMCID: PMC11272133 DOI: 10.7759/cureus.63137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Hippocampus protection, as an organ at risk in brain radiotherapy, might protect patients' quality of life. Prophylactic cranial irradiation (PCI) has been used traditionally in small cell lung cancer (SCLC) patients as it increases survival. This study aimed to discover the contributing parameters for a successful PCI with simultaneous protection of the hippocampus by using three different treatment machines. For this purpose, treatment plans were generated for 45 SCLC patients using three half-arcs in three linear accelerators (LINACs; Elekta Infinity, Synergy, and Axesse; Elekta Ltd, Stockholm, Sweden) with different radiation field sizes and multileaf collimator (MLC) leaf thickness characteristics. The prescribed dose was 25 Gy in 10 fractions. Thresholds for the hippocampus were calculated based on the Radiation Therapy Oncology Group 0933 dose constraints. The planning and treatment system templates were common to all three LINACs. Plan evaluation was based on the dosimetric target coverage by the 95% isodose, the maximum dose of the plan, the conformity index (CI), the degree of plan modulation (MOD), and the patient-specific quality assurance (QA) pass rate. The mean target coverage was highest for Infinity (97.3%), followed by Axesse (96.6%) and Synergy (95.5%). The mean maximum dose was higher for Synergy (27.5 Gy), followed by Infinity (27.0 Gy) and Axesse (26.9 Gy). Axesse plans had the highest CI (0.93), followed by Infinity (0.91) and Synergy (0.88). Plan MOD was lower for Synergy (2.88) compared with Infinity (3.07) and Axesse (3.69). Finally, patient-specific QA was successful in all Infinity plans, in all but one Synergy plan, and in 17/45 Axesse plans, as was expected from the field size in that treatment unit. Based on overall performance, the most favorable combination of target coverage, hippocampus sparing, and plan deliverability was obtained with the LINAC, which has the largest field opening and thinnest MLC leaves.
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Affiliation(s)
- Georgios Giakoumettis
- Medical Physics and Digital Innovation Laboratory, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Areti Gkantaifi
- Radiation Oncology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Radiation Oncology, Theagenio Cancer Hospital of Thessaloniki, Thessaloniki, GRC
| | - Dimitrios Giakoumettis
- Neurosurgery, Agios Savvas, General Anticancer-Oncological Hospital of Athens, Athens, GRC
| | - Emmanouil Papanastasiou
- Medical Physics and Digital Innovation Laboratory, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgios Plataniotis
- Radiation Oncology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Despoina Misailidou
- Radiation Oncology, Interbalkan European Medical Center of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Kouskouras
- Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | - Anastasios Siountas
- Medical Physics and Digital Innovation Laboratory, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Han YM, Ou D, Chai WM, Yang WL, Liu YL, Xiao JF, Zhang W, Qi WX, Chen JY. Exploration of anatomical distribution of brain metastasis from breast cancer at first diagnosis assisted by artificial intelligence. Heliyon 2024; 10:e29350. [PMID: 38694110 PMCID: PMC11061689 DOI: 10.1016/j.heliyon.2024.e29350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024] Open
Abstract
Objectives This study aimed to explore the spatial distribution of brain metastases (BMs) from breast cancer (BC) and to identify the high-risk sub-structures in BMs that are involved at first diagnosis. Methods Magnetic resonance imaging (MRI) scans were retrospectively reviewed at our centre. The brain was divided into eight regions according to its anatomy and function, and the volume of each region was calculated. The identification and volume calculation of metastatic brain lesions were accomplished using an automatically segmented 3D BUC-Net model. The observed and expected rates of BMs were compared using 2-tailed proportional hypothesis testing. Results A total of 250 patients with BC who presented with 1694 BMs were retrospectively identified. The overall observed incidences of the substructures were as follows: cerebellum, 42.1 %; frontal lobe, 20.1 %; occipital lobe, 9.7 %; temporal lobe, 8.0 %; parietal lobe, 13.1 %; thalamus, 4.7 %; brainstem, 0.9 %; and hippocampus, 1.3 %. Compared with the expected rate based on the volume of different brain regions, the cerebellum, occipital lobe, and thalamus were identified as higher risk regions for BMs (P value ≤ 5.6*10-3). Sub-group analysis according to the type of BC indicated that patients with triple-negative BC had a high risk of involvement of the hippocampus and brainstem. Conclusions Among patients with BC, the cerebellum, occipital lobe and thalamus were identified as higher-risk regions than expected for BMs. The brainstem and hippocampus were high-risk areas of the BMs in triple negative breast cancer. However, further validation of this conclusion requires a larger sample size.
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Affiliation(s)
- Yi-min Han
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dan Ou
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei-min Chai
- Department of Radiology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-lei Yang
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying-long Liu
- United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China
| | - Ji-feng Xiao
- United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China
| | - Wei Zhang
- Shanghai United Imaging Healthcare Co., Ltd. Shanghai, China
| | - Wei-xiang Qi
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Buczek D, Zaucha R, Jassem J. Neurotoxicity-sparing radiotherapy for brain metastases in breast cancer: a narrative review. Front Oncol 2024; 13:1215426. [PMID: 38370347 PMCID: PMC10869626 DOI: 10.3389/fonc.2023.1215426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/19/2023] [Indexed: 02/20/2024] Open
Abstract
Breast cancer brain metastasis (BCBM) has a devastating impact on patient survival, cognitive function and quality of life. Radiotherapy remains the standard management of BM but may result in considerable neurotoxicity. Herein, we describe the current knowledge on methods for reducing radiation-induced cognitive dysfunction in patients with BCBM. A better understanding of the biology and molecular underpinnings of BCBM, as well as more sophisticated prognostic models and individualized treatment approaches, have appeared to enable more effective neuroprotection. The therapeutic armamentarium has expanded from surgery and whole-brain radiotherapy to stereotactic radiosurgery, targeted therapies and immunotherapies, used sequentially or in combination. Advances in neuroimaging have allowed more accurate screening for intracranial metastases, precise targeting of intracranial lesions and the differentiation of the effects of treatment from disease progression. The availability of numerous treatment options for patients with BCBM and multidisciplinary approaches have led to personalized treatment and improved therapeutic outcomes. Ongoing studies may define the optimal sequencing of available and emerging treatment options for patients with BCBM.
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Kim TH, Cho J, Kang SG, Moon JH, Suh CO, Park YW, Chang JH, Yoon HI. High Radiation Dose to the Fornix Causes Symptomatic Radiation Necrosis in Patients with Anaplastic Oligodendroglioma. Yonsei Med J 2024; 65:1-9. [PMID: 38154474 PMCID: PMC10774647 DOI: 10.3349/ymj.2023.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE Surgery, radiotherapy (RT), and chemotherapy have prolonged the survival of patients with anaplastic oligodendroglioma. However, whether RT induces long-term toxicity remains unknown. We analyzed the relationship between the RT dose to the fornix and symptomatic radiation necrosis (SRN). MATERIALS AND METHODS A total of 67 patients treated between 2009 and 2019 were analyzed. SRN was defined according to the following three criteria: 1) radiographic findings, 2) symptoms attributable to the lesion, and 3) treatment resulting in symptom improvement. Various contours, including the fornix, were delineated. Univariate and multivariate analyses of the relationship between RT dose and SRN, as well as receiver operating characteristic curve analysis for cut-off values, were performed. RESULTS The most common location was the frontal lobe (n=40, 60%). Gross total resection was performed in 38 patients (57%), and 42 patients (63%) received procarbazine, lomustine, and vincristine chemotherapy. With a median follow-up of 42 months, the median overall and progression-free survival was 74 months. Sixteen patients (24%) developed SRN. In multivariate analysis, age and maximum dose to the fornix were associated with the development of SRN. The cut-off values for the maximum dose to the fornix and age were 59 Gy (equivalent dose delivered in 2 Gy fractions) and 46 years, respectively. The rate of SRN was higher in patients whose maximum dose to the fornix was >59 Gy (13% vs. 43%, p=0.005). CONCLUSION The maximum dose to the fornix was a significant factor for SRN development. While fornix sparing may help maintain neurocognitive function, additional studies are needed.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea.
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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Zhang H, Hu B, Pang H. Dosimetric comparison of helical tomotherapy and volumetric modulated arc therapy in hippocampal avoidance whole-brain radiotherapy. J Appl Clin Med Phys 2024; 25:e14218. [PMID: 38013656 PMCID: PMC10795432 DOI: 10.1002/acm2.14218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/06/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE This study aimed to discuss the dosimetric advantages of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) technology in hippocampal avoidance whole-brain radiotherapy and provide references for clinical selection of ideal radiotherapy technology. METHODS A total of 20 patients with hippocampal avoidance whole-brain radiotherapy were chosen randomly. Computed tomography (CT) and MRI scanning images were input into the treatment planning system (TPS). After the CT and enhanced magnetic resonance T1 weighted images were fused and registered, the same radiation therapy physician was invited to outline the tumor target volume. PTV-HS refers to the whole brain subtracted by 5 mm outward expansion of the hippocampus (HP). The prescribed dose was 30 Gy/10 fractions. HT and VMAT plans were designed for each patient in accordance with PTV. Under the premise that the 95% isodose curve covers the PTV, dose-volume histogram was applied to evaluate the PTV, conformal index (CI), heterogeneity index (HI), maximum dose (Dmax), mean dose (Dmean), minimum dose (Dmin) and absorbed doses of organs at risk (OARs) in HT and VMAT plans. Paired t-test was performed to compare the differences between two radiation therapy plans, and p < 0.05 was considered statistically significant. RESULTS These two plans had no significant difference in PTV-HS (max, min, and mean). However, the HI and CI of the HT plan were significantly better than those of the VMAT plan, showing statistically significant difference (p < 0.05). The HT plan was significantly superior to the VMAT plan in terms of the Dmax, Dmin, and Dmean of HP, left and right eye lens, left and right eye, and spinal cord, showing statistically significant difference (p < 0.05). The HT plan was also better than the VMAT plan in terms of the Dmax of the left optic nerve. However, the two plans showed no obvious differences in terms of the absorbed doses of the right optic nerve and brainstem, without statistical significance. CONCLUSIONS Compared with the VMAT plan of hippocampal avoidance, HT technology has significant dosimetric advantages. HT plans significantly decreased the radiation dose and radiation volume of OARs surrounding the target area (e.g., surrounding eye lens and eye, especially hippocampal avoidance area) while increasing the CI and HI of PTV dose in whole brain radiotherapy (WBRT) greatly, thus enabling the decrease in the incidence rate of radioactive nerve function impairment.
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Affiliation(s)
- Huai‐wen Zhang
- Department of RadiotherapyJiangxi Cancer HospitalThe Second Affiliated Hospital of Nanchang Medical College NHCKey Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal CarcinomaNanchangChina
- Department of Oncology, The third people's hospital of JingdezhenThe third people's hospital of Jingdezhen affiliated to Nanchang Medical CollegeJingdezhenChina
| | - Bo Hu
- Key Laboratory of Nondestructive Testing of Ministry of EducationNanchang HangKong UniversityNanchangChina
| | - Hao‐wen Pang
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversitySichuanChina
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10
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Gai X, Su L, Huang S, Zeng J, Guo F, Cai C, Lv W, Liu F, Li S, Hong J. Correlation between hippocampal radiation doses and psychological condition for patients with stage T1-2 nasopharyngeal carcinoma. Radiother Oncol 2023; 189:109942. [PMID: 37813310 DOI: 10.1016/j.radonc.2023.109942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND PURPOSE The study aimed to investigate the correlation between radiation doses to the hippocampi and the psychological status of patients with stage T1-2 nasopharyngeal carcinoma (NPC) undergoing intensity modulated radiotherapy (IMRT) and recommend proper hippocampal dose limits for preserving patients' psychological well-being. MATERIALS AND METHODS A retrospective study was conducted involving 152 newly diagnosed NPC patients. The patients' psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS) before and after radiotherapy. The hippocampi were manually delineated on treatment planning images, and dosimetric parameters were obtained from dose-volume histograms. Logistic regression analysis was performed to identify influential dosimetric factors associated with anxiety and depression. RESULTS The results showed that several dosimetric parameters to the hippocampi were significantly associated with anxiety but not depression. The optimal cut-off value for the independent predictor of anxiety was determined as D40 to hippocampi > 1500 cGy. Patients with D40 to hippocampi > 1500 cGy showed a higher probability for anxiety after radiotherapy. CONCLUSION This study provides insights into the relationship between radiation doses to the hippocampi and the psychological status of stage T1-2 NPC patients undergoing IMRT. It suggests the importance of hippocampal protection for preserving patients' psychological well-being. Further studies are needed to validate these results.
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Affiliation(s)
- Xiujuan Gai
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Department of Oncology, Laiyang Central Hospital of Yantai, Yantai 265200, China
| | - Li Su
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Shiqi Huang
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China
| | - Jiang Zeng
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Feibao Guo
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Chuanshu Cai
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Wenlong Lv
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Feng Liu
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Shan Li
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical Universisty, Fuzhou 350212, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
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11
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Ishikawa Y, Umezawa R, Yamamoto T, Takahashi N, Takeda K, Suzuki Y, Kishida K, Teramura S, Ito K, Jingu K. Pre-treatment Evaluation of Patients Eligible for Whole Brain Radiation Therapy: The Risk of Hippocampal Metastases in a Retrospective Study of 248 Cases at a Single Institution. Cureus 2023; 15:e49170. [PMID: 38024024 PMCID: PMC10662202 DOI: 10.7759/cureus.49170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/01/2023] Open
Abstract
Whole brain radiation therapy (WBRT) is effective for multiple brain metastases (BMs) but may impair neurocognitive function (NCF). The incidence of hippocampal metastasis (HM) is low, and the factors associated with the occurrence of HM remain unclear. This study aimed to assess the occurrence of limbic system metastasis (LSM), including HM, and to analyze the risk of HM. We retrospectively analyzed 248 patients who underwent three-dimensional conformal radiation therapy for BMs between May 2008 and October 2015. Gadolinium-enhanced brain MRI or CT scans were used for diagnosis. Statistical analysis involved assessing clinical factors, including age, gender, primary tumor, number of BMs, and maximum metastasis diameter, in relation to the presence of HMs using logistic regression and receiver operating characteristic (ROC) curve analysis. The median age at treatment was 62 years (range: 11-83 years). Primary lesion sites included the lung (n = 150; 60.5%), breast (n = 45; 18.1%), gastrointestinal tract (n = 18; 7.3%), and bone and soft tissue (n = 2; 0.8%). Histological cancer types included adenocarcinoma (n = 113; 45.6%), squamous cell carcinoma (n = 26; 10.5%), small cell carcinoma (n = 28; 11.3%), invasive ductal carcinoma (n = 35; 14.1%), sarcoma (n = 3; 1.2%), and others (n = 43; 17.3%). MRI or CT scans of the 248 patients were analyzed, indicating a total count of 2,163 brain metastases (median: five metastases per patient). HMs were identified in 18 (7.3%) patients. The most common location for LSMs was the cingulum/cingulate gyrus in 26 (10.5%) patients. In univariate and multivariate analyses, patients with 15 or fewer BMs had a significantly lower incidence of HMs (odds ratio (OR), 0.018 (95% confidence interval (CI), 0.030-0.24)) (p < 0.0001). A maximal tumor size of less than 2 cm significantly increased the incidence of HMs (OR, 13.8 (95%CI, 1.80-105.3)) (p = 0.0003). The presence of cingulum/cingulate gyrus metastases also demonstrated a significant increase in the incidence of HMs (OR, 9.42 (95%CI, 3.30-26.84)) (p < 0.0001). The present study has uncovered a novel association between a high number of metastases in the cingulate gyrus and the development of HMs. Patients with BMs eligible for WBRT with metastases in the cingulate gyrus may be at risk of developing HM.
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Affiliation(s)
- Yojiro Ishikawa
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
| | - Kazuya Takeda
- Department of Radiation Oncology, South Miyagi Medical Center, Ogawara, JPN
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
| | - Keita Kishida
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
| | - Satoshi Teramura
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Kengo Ito
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
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12
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Mazzarella C, Chiesa S, Toppi L, Hohaus S, Gaudino S, D'Alo F, Dinapoli N, Davide R, Zinicola T, Bracci S, Martino A, Beghella Bartoli F, Lepre E, Bertolini R, Mariani S, Colosimo C, Frascino V, Mattiucci GC, Gambacorta MA, Valentini V, Balducci M. May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? Radiat Oncol 2023; 18:161. [PMID: 37784190 PMCID: PMC10546760 DOI: 10.1186/s13014-023-02251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/27/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE One of the main limiting factors of whole-brain radiation therapy (WBRT) for primary central nervous system lymphoma (PCNSL) is the impairment of neurocognitive functions (NCFs), which is mainly caused by radiation-induced injury to the hippocampus. With a view to preventing NCF impairment and personalizing treatment, we explored the feasibility of sparing the hippocampus during WBRT by correlating the sites of PCNSL lesions with the hippocampus. METHODS AND MATERIALS Pre-treatment MR images from patients who underwent WBRT between 2010 and January 2020-and post-radiotherapy images in cases of relapse-were imported into the Varian Eclipse treatment-planning system and registered with the simulation CT. We constructed three 3-dimensional envelopes around the hippocampus at distances of 5, 10 and 15 mm and also contoured primary lesions and recurrences. RESULTS We analyzed 43 patients with 66 primary lesions: 9/66 (13.6%) involved the hippocampus and 11/66 (16.7%) were located within 5 mm of it. Thirty-six lesions (54.5%) were situated more than 15 mm from the hippocampus, while 10/66 (15.2%) were between 5 and 15 mm from it. The most common location was in deep brain structures (31%). Thirty-five of the 66 lesions relapsed: in field in 14/35 (40%) and outfield in 21/35 (60%) in different sites. Globally, 16/35 recurrences (45.7%) were located in the hippocampus or within 5 mm of it. CONCLUSION These data show that routinely sparing the hippocampus is not feasible. This approach could be considered in selected patients, when the lesion is more than 15 mm from the hippocampus.
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Affiliation(s)
- Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy.
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Lucrezia Toppi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Stefan Hohaus
- UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Gaudino
- UOC di Neuroradiologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco D'Alo
- UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Resta Davide
- UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Tiziano Zinicola
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Antonella Martino
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Elisabetta Lepre
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Roberta Bertolini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Silvia Mariani
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Cesare Colosimo
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Frascino
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Gian Carlo Mattiucci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Balducci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Steinruecke M, Pronin S, Gherman AV, Emelifeonwu J, Liaquat I. Survival and complications following supra- and infratentorial brain metastasis resection. Surgeon 2023; 21:e279-e286. [PMID: 36805302 DOI: 10.1016/j.surge.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/16/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE 15-30% of primary cancers metastasise to the brain. Of these, 10-25% involve the posterior fossa. It remains unclear whether patients undergoing resection for infratentorial brain metastases experience poorer prognosis than those with supratentorial lesions. We compare the post-operative outcomes of these two groups. METHODS We searched the electronic health records of all patients undergoing brain metastases resection at our regional neurosurgical centre between February 2014 and August 2019. Clinical data was collected on 85 consecutive patients (61 supratentorial, 24 infratentorial metastases). Outcome measures included overall survival, post-operative complications, and performance status. Patients were followed up until 21/04/2020. RESULTS Median post-operative survival of patients with supratentorial metastases was 323 days (95% CI 235-411), compared to 277 days (95% CI 195-359) for those with infratentorial metastases. These two groups experienced comparable survival (log rank = 0.276, p = 0.60) on univariate analysis. Infratentorial metastasis location was not associated with a change in survival using a Cox proportional hazards model incorporating age, sex and extracranial disease activity (HR = 1.39, 95% CI 0.777-2.486) (p = 0.27). However, neurological and non-neurological post-operative complications were more frequent in patients with infratentorial metastases (neurological = 21% vs 13%, non-neurological = 25% vs 2%, p = 0.002). CONCLUSION Patients with supra- and infratentorial metastases experienced comparable post-operative survival but posterior fossa metastasis location was associated with a 2.5 times higher risk of neurological and/or non-neurological post-operative complications. A better understanding of the precise indications for safe and effective surgical intervention for posterior fossa metastases is required.
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Affiliation(s)
- Moritz Steinruecke
- Edinburgh Medical School, The University of Edinburgh, Chancellor's Building, Edinburgh, EH16 4SB, UK; University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SP, UK.
| | - Savva Pronin
- Department of Clinical Neurosciences, Edinburgh BioQuarter, Edinburgh, EH16 4TJ, UK.
| | - Anda-Veronica Gherman
- Edinburgh Medical School, The University of Edinburgh, Chancellor's Building, Edinburgh, EH16 4SB, UK.
| | - John Emelifeonwu
- Department of Clinical Neurosciences, Edinburgh BioQuarter, Edinburgh, EH16 4TJ, UK.
| | - Imran Liaquat
- Department of Clinical Neurosciences, Edinburgh BioQuarter, Edinburgh, EH16 4TJ, UK.
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14
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Xi Q, Xie K, Zhang F, Li Q, Jiao Z, Ni X. Automatic delineation of hippocampus in CT images based on deep learning and dosimetry study in whole brain radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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15
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Dose reduction of hippocampus using HyperArc planning in postoperative radiotherapy for primary brain tumors. Med Dosim 2023; 48:67-72. [PMID: 36653285 DOI: 10.1016/j.meddos.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023]
Abstract
To compare dosimetric parameters for the hippocampus, organs at risk (OARs), and targets of volumetric modulated arc therapy (VMAT), noncoplanar VMAT (NC-VMAT), and HyperArc (HA) plans in patients undergoing postoperative radiotherapy for primary brain tumors. For 20 patients, HA plans were generated to deliver 40.05 to 60 Gy for the planning target volume (PTV). In addition, doses for the hippocampus and OARs were minimized. The VMAT and NC-VMAT plans were retrospectively generated using the same optimization parameters as those in the HA plans. For the hippocampus, the equivalent dose to be administered in 2 Gy fractions (EQD2) was calculated assuming α/β = 2. Dosimetric parameters for the PTV, hippocampus, and OARs in the VMAT, NC-VMAT, and HA plans were compared. For PTV, the HA plans provided significantly lower Dmax and D1% than the VMAT and NC-VMAT plans (p < 0.05), whereas the D99% and Dmin were significantly higher (p < 0.05). For the contralateral hippocampus, the dosimetric parameters in the HA plans (8.1 ± 9.6, 6.5 ± 7.2, 5.6 ± 5.8, and 4.8 ± 4.7 Gy for D20%, D40%, D60% and D80%, respectively) were significantly smaller (p < 0.05) than those in the VMAT and NC-VMAT plans. Except for the optic chiasm, the Dmax in the HA plans (brainstem, lens, optic nerves, and retinas) was the smallest (p < 0.05). In addition, the doses in the HA plans for the brain and skin were the smallest (p < 0.05) among the 3 plans. HA planning, instead of coplanar and noncoplanar VMAT, significantly reduces the dosage to which the contralateral hippocampus as well as other OARs are exposed without compromising on target coverage.
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Mampre D, Mehkri Y, Rajkumar S, Sriram S, Hernandez J, Lucke-Wold B, Chandra V. Treatment of breast cancer brain metastases: radiotherapy and emerging preclinical approaches. DIAGNOSTICS AND THERAPEUTICS 2022; 1:25-38. [PMID: 35782783 PMCID: PMC9249118 DOI: 10.55976/dt.1202216523-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The breast is one of the common primary sites of brain metastases (BM). Radiotherapy for BM from breast cancer may include whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and stereotactic radiotherapy (SRT), but a consensus is difficult to reach because of the wide and varied protocols, indications, and outcomes of these interventions. Overall, dissemination of disease, patient functional status, and tumor size are all important factors in the decision of treatment with WBRT or SRS. Thus far, previous studies indicate that WBRT can improve tumor control compared to SRS, but increase side effects, however no randomized trials have compared the efficacy of these therapies in BM from breast cancer. Therapies targeting long non-coding RNAs and transcription factors, such as MALAT1, HOTAIR, lnc-BM, TGL1, and ATF3, have the potential to both prevent metastatic spread and treat BM with improved radiosensitivity. Given the propensity for HER2+ breast cancer to develop BM, the above-mentioned cell lines may represent an important target for future investigations, and the development of everolimus and pyrotinib are equally important.
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Affiliation(s)
- David Mampre
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | - Yusuf Mehkri
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | | | - Sai Sriram
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | - Jairo Hernandez
- Department of Neurosurgery, University of Florida, Gainesville, FL
| | | | - Vyshak Chandra
- Department of Neurosurgery, University of Florida, Gainesville, FL
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Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review. Cancers (Basel) 2022; 14:cancers14112736. [PMID: 35681716 PMCID: PMC9179311 DOI: 10.3390/cancers14112736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Decline in cognitive function is a major problem for patients undergoing whole-brain radiotherapy (WBRT). Scientific interest has increased due to the high dropout rate of patients in the first months after WBRT and the early onset of cognitive decline. Therefore, the study of antiglutamatergic pharmacological prophylaxis and hippocampal-sparing WBRT techniques has been deepened based on the knowledge of the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline. In order to provide a summary of the evidence in this field, and to foster future research in this setting, this literature review presents current evidence on the prevention of radiation-induced cognitive decline and particularly on the role of memantine. Abstract Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects.
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Shieh LT, Lee SW, Chen CC, Ho YC, Wang YW, Ho SY. Perihippocampal failure after hippocampal-avoidance whole-brain radiotherapy in cancer patients with brain metastases: Results of a retrospective analysis. Medicine (Baltimore) 2022; 101:e29144. [PMID: 35446298 PMCID: PMC9276266 DOI: 10.1097/md.0000000000029144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 01/04/2023] Open
Abstract
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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Affiliation(s)
- Li-Tsun Shieh
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Sung-Wei Lee
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chia-Chun Chen
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Yi-Chia Ho
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yu-Wen Wang
- Department of Radiation Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Sheng-Yow Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
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19
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Li AY, Gaebe K, Jerzak KJ, Cheema PK, Sahgal A, Das S. Intracranial Metastatic Disease: Present Challenges, Future Opportunities. Front Oncol 2022; 12:855182. [PMID: 35330715 PMCID: PMC8940535 DOI: 10.3389/fonc.2022.855182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Intracranial metastatic disease (IMD) is a prevalent complication of cancer that significantly limits patient survival and quality of life. Over the past half-century, our understanding of the epidemiology and pathogenesis of IMD has improved and enabled the development of surveillance and treatment algorithms based on prognostic factors and tumor biomolecular characteristics. In addition to advances in surgical resection and radiation therapy, the treatment of IMD has evolved to include monoclonal antibodies and small molecule antagonists of tumor-promoting proteins or endogenous immune checkpoint inhibitors. Moreover, improvements in the sensitivity and specificity of imaging as well as the development of new serological assays to detect brain metastases promise to revolutionize IMD diagnosis. In this review, we will explore current treatment principles in patients with IMD, including the emerging role of targeted and immunotherapy in select primary cancers, and discuss potential areas for further investigation.
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Affiliation(s)
- Alyssa Y Li
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karolina Gaebe
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katarzyna J Jerzak
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Parneet K Cheema
- Division of Oncology, William Osler Health System, Brampton, ON, Canada
| | - Arjun Sahgal
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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20
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Zhu Y, Zhang J, Li C, Deng G, Li J, Liu X, Wan B, Tian Y. Porous Se@SiO 2 Nanoparticles Attenuate Radiation-Induced Cognitive Dysfunction via Modulating Reactive Oxygen Species. ACS Biomater Sci Eng 2022; 8:1342-1353. [PMID: 35230821 DOI: 10.1021/acsbiomaterials.1c01571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Radiotherapy has been widely used to manage primary and metastatic brain tumors. However, hippocampal damage and subsequent cognitive dysfunction are common complications of whole brain radiation (WBI). In this study, Se@SiO2 nanoparticles (NPs) with antioxidant properties were synthesized. Se@SiO2 NPs were characterized using X-ray diffraction (XRD) and transmission electron microscopy (TEM). The reactive oxygen species (ROS) scavenging ability of Se@SiO2 NPs was assessed using a dichloro-dihydro-fluorescein diacetate (DCFH-DA) probe. Apoptosis of HT-22 cells treated with H2O2 and Se@SiO2 NPs was assessed by annexin V-FITC/PI and JC-1 staining. Western blotting was used to evaluate inflammation-related signaling pathways. In vivo, the distribution and excretion of Se@SiO2 NPs were assessed using in vivo imaging system (IVIS). The biosafety and antioxidant effects of Se@SiO2 NPs were assessed. Neurogenesis in the hippocampus of mice was detected through neuron-specific nuclear protein (NeuN) and 5-bromo-2'-deoxyuridine (BrdU) immunofluorescence staining. The cognitive abilities of mice were also assessed using the Morris water maze test. Results showed that porous Se@SiO2 NPs were successfully synthesized with uniform spherical structures. In vitro, Se@SiO2 NPs inhibited ROS levels in mouse hippocampal neuronal cell line HT-22 treated with H2O2. Furthermore, Se@SiO2 NPs suppressed the apoptotic rate of HT-22 cells by regulating apoptosis-related proteins. Se@SiO2 NPs regulated the nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways, thereby reducing the expression of inflammatory factors. In vivo, Se@SiO2 NPs showed high biocompatibility at a concentration of 1.25 μg/μL. Se@SiO2 NPs inhibited ROS and promoted neurogenesis in the hippocampus, as well as improved cognitive ability in radiation-induced mice. In conclusion, Se@SiO2 NPs protected the hippocampus from oxidative stress injury and neuroinflammation. Se@SiO2 NPs treatment may be a potential therapeutic strategy for radiation-induced cognitive dysfunction.
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Affiliation(s)
- Yiwen Zhu
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiation Oncology, Soochow University, San Xiang Road No. 1055, Suzhou 215004, Jiangsu, China
| | - Junjun Zhang
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiation Oncology, Soochow University, San Xiang Road No. 1055, Suzhou 215004, Jiangsu, China
| | - Chunlin Li
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201620, China
| | - Guoying Deng
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201620, China
| | - Junyan Li
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiation Oncology, Soochow University, San Xiang Road No. 1055, Suzhou 215004, Jiangsu, China
| | - Xijian Liu
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Bo Wan
- Institute of Neuroscience, Soochow University, Renai Road No. 199, Suzhou 215123, Jiangsu, China
| | - Ye Tian
- Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University, Institute of Radiation Oncology, Soochow University, San Xiang Road No. 1055, Suzhou 215004, Jiangsu, China
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21
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Metastatic Neoplasm Volume Kinetics Following Two-Staged Stereotactic Radiosurgery. World Neurosurg 2022; 161:e210-e219. [PMID: 35123024 DOI: 10.1016/j.wneu.2022.01.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Multisession staged stereotactic radiosurgery (2-SSRS) represents an alternative approach for management of large brain metastases (LBMs), with potential advantages over fractionated SRS. We investigated the clinical efficacy and safety of 2-SSRS in patients with LBMs. METHODS LBMs patients treated with 2-SSRS between 2014-2020 were evaluated. Demographic, clinical, and radiologic information was obtained. Volumetric measurements at first SSRS, second SSRS, and follow-up imaging studies were obtained. Characteristics that might predict response to 2-SSRS were evaluated through Fischer-exact or Mann-Whitney U test. RESULTS Twenty-four patients with 26 LBMs were included in the study. Median marginal doses for first and second SSRS were 15 Gy (14-18 Gy) and 15 Gy (12-16 Gy), respectively. Median tumor volumes at first SSRS, second SSRS, and 3-month follow-up were 8.1 cm3 (1.5-28.5 cm3), 3.3 cm3 (0.8-26.1 cm3), and 2.2 cm3 (0.2-10.1 cm3), respectively. Overall, 24/26 lesions (92%) demonstrated early local control following the first SSRS with 17 lesions (71%) demonstrating a decrease of >30% in the T1 post-contrast MRI volume before the second SSRS and 3 lesions (12%) remaining stable. Eventually, four lesions showed disease progression after 2-SSRS. The median time to local progression was not reached and the median time to intracranial progression was 9.1 months. CONCLUSIONS Our study supports the effectiveness and safety of 2-SSRS as a treatment modality for patients with large, symptomatic brain metastases, especially in poor surgical candidates. The local failure rate and low occurrence of adverse effects are comparable to other staged radiosurgery studies.
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22
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Cardinal T, Pangal D, Strickland BA, Newton P, Mahmoodifar S, Mason J, Craig D, Simon T, Tew BY, Yu M, Yang W, Chang E, Cabeen RP, Ruzevick J, Toga AW, Neman J, Salhia B, Zada G. Anatomical and topographical variations in the distribution of brain metastases based on primary cancer origin and molecular subtypes: a systematic review. Neurooncol Adv 2022; 4:vdab170. [PMID: 35024611 PMCID: PMC8739649 DOI: 10.1093/noajnl/vdab170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background While it has been suspected that different primary cancers have varying predilections for metastasis in certain brain regions, recent advances in neuroimaging and spatial modeling analytics have facilitated further exploration into this field. Methods A systematic electronic database search for studies analyzing the distribution of brain metastases (BMs) from any primary systematic cancer published between January 1990 and July 2020 was conducted using PRISMA guidelines. Results Two authors independently reviewed 1957 abstracts, 46 of which underwent full-text analysis. A third author arbitrated both lists; 13 studies met inclusion/exclusion criteria. All were retrospective single- or multi-institution database reviews analyzing over 8227 BMs from 2599 patients with breast (8 studies), lung (7 studies), melanoma (5 studies), gastrointestinal (4 studies), renal (3 studies), and prostate (1 study) cancers. Breast, lung, and colorectal cancers tended to metastasize to more posterior/caudal topographic and vascular neuroanatomical regions, particularly the cerebellum, with notable differences based on subtype and receptor expression. HER-2-positive breast cancers were less likely to arise in the frontal lobes or subcortical region, while ER-positive and PR-positive breast metastases were less likely to arise in the occipital lobe or cerebellum. BM from lung adenocarcinoma tended to arise in the frontal lobes and squamous cell carcinoma in the cerebellum. Melanoma metastasized more to the frontal and temporal lobes. Conclusion The observed topographical distribution of BM likely develops based on primary cancer type, molecular subtype, and genetic profile. Further studies analyzing this association and relationships to vascular distribution are merited to potentially improve patient treatment and outcomes.
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Affiliation(s)
- Tyler Cardinal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Dhiraj Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Paul Newton
- Department of Aerospace and Mechanical Engineering, Mathematics and The Ellison Institute for Transformative Medicine of USC, Los Angeles, California, USA
| | - Saeedeh Mahmoodifar
- Department of Physics & Astronomy, University of Southern California, Los Angeles, California, USA
| | - Jeremy Mason
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - David Craig
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Thomas Simon
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben Yi Tew
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Min Yu
- Broad Stem Cell Center, University of Southern California, Los Angeles, California, USA
| | - Wensha Yang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Eric Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Ryan P Cabeen
- USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Jacob Ruzevick
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Josh Neman
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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23
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Fu Q, Chen D, Yan H, Chen J, Zhu J, Yan L, Xu Y, Deng L, Men K, Dai J. Treatment planning of volumetric modulated arc therapy and positioning optimization for hippocampal-avoidance prophylactic cranial irradiation. J Appl Clin Med Phys 2021; 22:15-23. [PMID: 33829650 PMCID: PMC8130238 DOI: 10.1002/acm2.13217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/05/2021] [Accepted: 02/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hippocampal-avoidance prophylactic cranial irradiation (HA-PCI) offers potential neurocognitive benefits but raises technical challenges to treatment planning. This study aims to improve the conventional planning method using volumetric modulated arc therapy (VMAT) technique and investigate a better patient's head positioning to achieve a high quality of HA-PCI treatment plans. METHODS The improved planning method set a wide expansion of hippocampus as a special region for dose decline. The whole brain target was divided into two parts according to whether the slice included hippocampus and their optimization objectives were set separately. Four coplanar full arcs with partial field sizes were employed to deliver radiation dose to different parts of the target. The collimator angle for all arcs was 90°. Tilting patient's head was achieved by rotating CT images. The improved planning method and tilted head positioning were verified using datasets from 16 patients previously treated with HA-PCI using helical tomotherapy (HT). RESULTS For the improved VMAT plans, the max and mean doses to hippocampus were 7.88 Gy and 6.32 Gy, respectively, significantly lower than those for the conventional VMAT plans (P < 0.001). Meanwhile, the improved planning method significantly improved the plan quality. Compared to the HT plans, the improved VMAT plans result in similar mean dose to hippocampus (P > 0.1) but lower max dose (P < 0.02). Besides, the target coverage was the highest for the improved VMAT plans. The tilted head positioning further reduced the max and mean doses to hippocampus (P < 0.05), significantly decreased the max dose to lens (P < 0.001) and resulted in higher plan quality as compared to nontilted head positioning. CONCLUSIONS The improved planning method enables the VMAT plans to meet the clinical requirements of HA-PCI treatment with high plan quality and convenience. The tilted head positioning provides superior dosimetric advantages over the nontilted head positioning, which is recommended for clinical application.
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Affiliation(s)
- Qi Fu
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Deqi Chen
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Hui Yan
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Jiayun Chen
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Ji Zhu
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Lingling Yan
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Yingjie Xu
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Lei Deng
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Kuo Men
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
| | - Jianrong Dai
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijingChina
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Cho Y, Lee J, Lee IJ, Kim JW, Baek JG, Jung DM, Cho BC, Hong MH, Kim HR, Lee CG, Yoon HI. Intracranial failure after hippocampal-avoidance prophylactic cranial irradiation in limited-stage small-cell lung cancer patients. Sci Rep 2021; 11:7435. [PMID: 33795826 PMCID: PMC8016941 DOI: 10.1038/s41598-021-86851-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Abstract
We evaluated intracranial failure after hippocampus-avoidance-prophylactic cranial irradiation (HA-PCI) for limited-stage small-cell lung cancer (SCLC). Data of 106 patients who received PCI with 25 Gy were retrospectively reviewed. The patients were divided into two groups based on whether they underwent HA-PCI: the HA-PCI group (n = 48) and the conventional PCI (C-PCI) group (n = 58). Twenty-one patients experienced intracranial failure: 11 and 10 patients in the C-PCI and HA-PCI groups, respectively. Using the log-rank test, the intracranial failure rate was not significantly different between the groups (p = 0.215). No clinical factor was significantly associated with intracranial failure in multivariate Cox regression analysis, but HA-PCI tended to be associated with increased incidence of intracranial failure (HR 2.87, 95% CI 0.86–9.58, p = 0.087). Among patients who received HA-PCI, two developed peri-hippocampal recurrence. A higher thoracic radiotherapy dose (≥ 60 Gy) was significantly associated with DFS (HR 0.52, p = 0.048) and OS (HR 0.35, p = 0.003). However, HA-PCI was associated with neither DFS nor OS. Although HA-PCI may be associated with an increased risk of intracranial failure, HA-PCI did not impair disease control or survival. Future prospective randomized trials are needed to reach a definite conclusion.
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Affiliation(s)
- Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Geol Baek
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong Min Jung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Byoung Chul Cho
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Hee Hong
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Ryun Kim
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Kaya I, Cingoz ID, Gursoy M, Atar M, Guvenc G, Uzunoglu I, Sahin MC, Yuceer N. Edema-mass Ratio Based On Magnetic Resonance Imaging As A Preoperative Diagnostic Factor For Posterior Fossa Metastasis. Curr Med Imaging 2021; 17:762-766. [PMID: 33655873 DOI: 10.2174/1573405617666210303105006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peritumoral edema of primary brain tumors is an important cause of morbidity and mortality. The number of studies currently available on the prognostic role of peritumoral brain edema in the posterior fossa is extremely limited. OBJECTIVE Based on the known importance of magnetic resonance imaging in diagnosing supratentorial metastases, this study aimed to investigate the effects of peritumoral edema on survival of patients with posterior fossa metastases and the preoperative diagnostic value of MRI. METHODS Edema and mass volumes of 49 patients with posterior fossa metastasis, who underwent surgery during 2012-2016, were measured using magnetic resonance imaging. The edema/mass indices were retrospectively calculated and interpreted by evaluating the demographic, clinical, and survival data. RESULTS The study consisted of 32 (65.3%) male and 17 (34.7%) female participants, with the mean age ± standard deviation of 47.25±29.25 (17-81) years. Among the 49 patients with posterior fossa metastases, 34 (69.4%) had carcinoma, while 15 (30.6%) had non-carcinoma metastases. The edema/mass indices of patients with carcinoma and non-carcinoma metastases were found to be 14.55±9.64 and 1.34±1.08, respectively, and the difference was statistically significant (p<0.001). The mean survival of patients with carcinoma and non-carcinoma metastases was found to be 642±11.52 days and 726±9.32 days, respectively; however, this difference was not statistically significant (p=0.787). CONCLUSION The edema/mass ratio was found to be a significant diagnostic factor for the prediction of posterior fossa metastases. Further detailed studies are warranted to investigate the effect of edema/mass ratio on survival rate.
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Affiliation(s)
- Ismail Kaya
- Department of Neurosurgery, Kutahya Health Science University, Medical Faculty, Kutahya, Turkey
| | - Ilker Deniz Cingoz
- Department of Neurosurgery, Kutahya Health Science University, Medical Faculty, Kutahya, Turkey
| | - Merve Gursoy
- Department of Radiology, Izmir Democracy University, Medical Faculty, Izmir, Turkey
| | - Murat Atar
- Department of Neurosurgery, ISAH Sample Training and Research Hospital, Istanbul, Turkey
| | - Gonul Guvenc
- Department of Neurosurgery, Katip Celebi University, Medical Faculty, Izmir, Turkey
| | - Inan Uzunoglu
- Department of Neurosurgery, Katip Celebi University, Medical Faculty, Izmir, Turkey
| | - Meryem Cansu Sahin
- Training and Research Center, Kutahya Health Science University, Kutahya, Turkey
| | - Nurullah Yuceer
- Department of Neurosurgery, Katip Celebi University, Medical Faculty, Izmir, Turkey
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26
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Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education. Crit Rev Oncol Hematol 2021; 159:103229. [PMID: 33482343 DOI: 10.1016/j.critrevonc.2021.103229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/09/2020] [Accepted: 01/16/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS The limbic circuit (LC) is devoted to linking emotion to behavior and cognition. The injury this system results in post-RT cognitive dysfunction. The aim of this study is to create the first radiation oncologist's practical MR-based contouring guide for the delineation of the LC for the everyday clinical practice and education. METHODS An anonymized diagnostic 3.0 T T1-weighted BRAVO MRI sequence from a healthy patient with typical brain anatomy was used to delineate LC. For each structure key anatomical contours were completed by radiation oncologists, along with a neuro-radiologist to generate the final version of the LC atlas. RESULTS a step-by-step MR-based atlas of LC was created. Key structures of the LC, such as, cingulate gyrus, fornix, septal region, mammillary bodies, thalamus and the hippocampal-amygdala formation were contoured. CONCLUSIONS This article provides the recommendations for the first contouring atlas of LC in the setting of patients receiving RT and education.
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Wang D, Ma X, Fu L, Gu J, Bai T, Yin Y, Li B, Zhu J. The Capabilities and Characteristics of Helical Tomotherapy and Co-Planar Dual Arcs Volumetric-Modulated arc Therapy Associated with Hippocampal Sparing During Prophylactic Cranial Irradiation. Technol Cancer Res Treat 2021; 20:15330338211043975. [PMID: 34632869 PMCID: PMC8504218 DOI: 10.1177/15330338211043975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the features of helical tomotherapy and co-planar dual Arcs volumetric-modulated arc therapy during prophylactic cranial irradiation associated with bilateral hippocampal tissue sparing. Materials and methods: Helical tomotherapy and co-planar dual arcs volumetric-modulated arc therapy treatment plans were generated with a dose of 30 Gy/10 fractions in 16 patients treated with prophylactic cranial irradiation. The dose to the bilateral hippocampal tissues, organs at risk, and planning target volume were determined when the average dose of bilateral hippocampal tissues was reduced by approximately 4 Gy as an observation point. Changes in dosimetry when sparing the bilateral hippocampal tissues were determined for both modalities. Results: When bilateral hippocampal tissues were restricted to 8 Gy, D40%mean-bilateral hippocampal tissues = 7.64 ± 0.41 Gy in helical tomotherapy, while D40%mean-bilateral hippocampal tissues = 10.96 ± 0.38 Gy in co-planar dual arcs volumetric-modulated arc therapy volumetric-modulated arc therapy. Helical tomotherapy was associated with significantly lower doses to organs at risk, including Dmean-bilateral hippocampal tissues (P = .03), D98%-bilateral hippocampal tissues (P = .01), D2%-bilateral hippocampal tissues (P = .01), Dmean-inner ear (P = .02), Dmean-parotid glands (P = .02), Dmax-lens (P = .02), and Dmax-brainstem (P = .02), but not Dmax-optic nerves (P = .87). Helical tomotherapy provided better target coverage, with lower average D2%-PTV (P = .02), higher average D98%-PTV (P = .02), and better conformal index (0.87 vs 0.84, P = .02) and homogeneity index (0.15 vs 0.21, P = .05). With smaller bilateral hippocampal tissues doses, the planning target volume dose changed across 3 dosimetry regions for both modalities; the plateau region (>20.0 Gy for helical tomotherapy versus >16.0 Gy for co-planar dual arcs volumetric-modulated arc therapy), gradient region (20.0-12.0 Gy vs 16.0-11.0 Gy), and falling region (<12.0 Gy vs <11.0 Gy). The average delivery duration of helical tomotherapy was almost 7.7 times longer than that of co-planar dual arcs volumetric-modulated arc therapy. Conclusions: Helical tomotherapy was better at sparing the bilateral hippocampal tissues and organs at risk and had better target coverage but a significantly longer treatment duration than co-planar dual arcs volumetric-modulated arc therapy. Further dose decreases in the bilateral hippocampal tissues would yield worse target dose coverage.
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Affiliation(s)
- Dandan Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xingmin Ma
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lu Fu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jiabing Gu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tong Bai
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Baosheng Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Shandong Medical Imaging and Radiotherapy Engineering Technology Research Center, Jinan, China
| | - Jian Zhu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Shandong Medical Imaging and Radiotherapy Engineering Technology Research Center, Jinan, China
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Yang ZR, Liu MN, Yu JH, Yang YH, Chen TX, Han YC, Zhu L, Zhao JK, Fu XL, Cai XW. Treatment of stage III non-small cell lung cancer in the era of immunotherapy: pathological complete response to neoadjuvant pembrolizumab and chemotherapy. Transl Lung Cancer Res 2020; 9:2059-2073. [PMID: 33209626 PMCID: PMC7653116 DOI: 10.21037/tlcr-20-896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers. The expected 5-year survival of stage III NSCLC ranges from 13% to 36% for stage III. Due to the heterogeneity and poor efficacy of stage III patients, there is great controversy on how to optimize the therapy strategy. Immunotherapy is providing better clinical efficacy to more NSCLC patients, and is rapidly extending its range of care from advanced stage to locally advanced stage and early stage NSCLC. Due to the patient’s strong treatment intention, drug availability, and a few encouraging results from clinical trials (NADIM, NCT02716038, etc.), the authors observed a case of stage III NSCLC that achieved complete remission after receiving neoadjuvant chemotherapy combined with immunotherapy. In view of such a satisfactory result in neoadjuvant therapy, this article discusses how comprehensive treatment for stage III NSCLC patients may be conducted and the manner in which various therapeutic techniques can be mastered in the era of immunotherapy. Immunotherapy has opened the exploratory space for finding resolutions to numerous challenges of treating stage III NSCLC. Further clinical studies and exploration of personalized treatment, guided by imaging data, and clinical and pathological biomarkers are imperative for the benefit of these patients.
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Affiliation(s)
- Zhang-Ru Yang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mi-Na Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Hua Yu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Hai Yang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tian-Xiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Chen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ji-Kai Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xu-Wei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Starkweather CK, Choi BD, Alvarez-Breckenridge C, Brastianos PK, Oh K, Wang N, Shih H, Nahed BV. Initial Approach to the Patient with Multiple Newly Diagnosed Brain Metastases. Neurosurg Clin N Am 2020; 31:505-513. [PMID: 32921347 DOI: 10.1016/j.nec.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Brain metastases are the most common intracranial tumor in adults, with increasing incidence owing to prolonged survival times. Roughly half of patients diagnosed with new brain metastases have greater than 1 brain metastasis at the time of diagnosis, raising the question of how to optimize patient care with multiple brain metastases. The authors review studies relevant to the care of patients with brain metastasis, with emphasis on those relevant to the care of patients with multiple brain metastases. They discuss evolving strategies involving multiple modalities and the benefit of surgical management in patients with a large symptomatic brain metastasis.
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Affiliation(s)
- Clara Kwon Starkweather
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Bryan D Choi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | | | | | - Kevin Oh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Helen Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Yanagihara TK, McFaline-Figueroa JR, Giacalone NJ, Lee AW, Soni V, Hwang ME, Hsieh KT, Saraf A, Wu CC, Yang D, Wen PY, Ashamalla H, Aizer AA, Wang TJC, Huang RY. A low percentage of metastases in deep brain and temporal lobe structures. Neuro Oncol 2020; 21:640-647. [PMID: 30715520 DOI: 10.1093/neuonc/noz023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whole-brain radiotherapy (WBRT) in patients with brain metastases (BM) is associated with neurocognitive decline. Given its crucial role in learning and memory, efforts to mitigate this toxicity have mostly focused on sparing radiation to the hippocampus. We hypothesized that BM are not evenly distributed across the brain and that several additional areas may be avoided in WBRT based on a low risk of developing BM. METHODS We contoured 2757 lesions in a large, single-institution database of patients with newly diagnosed BM. BM centroids were mapped onto a standard brain atlas of 55 anatomic subunits and the observed percentage of BM was compared with what would be expected based on that region's volume. A region of interest (ROI) analysis was performed in a validation cohort of patients from 2 independent institutions using equivalence and one-sample hypothesis tests. RESULTS The brainstem and bilateral thalami, hippocampi, parahippocampal gyri, amygdala, and temporal poles had a cumulative risk of harboring a BM centroid of 4.83% in the initial cohort. This ROI was tested in 157 patients from the validation cohort and was found to have a 4.1% risk of developing BM, which was statistically equivalent between the 2 groups (P < 1 × 10-6, upper bound). CONCLUSION Several critical brain structures are at a low risk of developing BM. A risk-adapted approach to WBRT is worthy of further investigation and may mitigate the toxicities of conventional radiation.
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Affiliation(s)
- Ted K Yanagihara
- Department of Radiation Oncology, Weill Cornell Medical College, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - J Ricardo McFaline-Figueroa
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Nicholas J Giacalone
- Department of Radiation Oncology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Albert W Lee
- State University of New York Downstate Medical Center, Brooklyn, New York
| | - Vikram Soni
- Department of Radiation Oncology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Mark E Hwang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Kristin T Hsieh
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Anurag Saraf
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Daniel Yang
- Department of Radiology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Hani Ashamalla
- Department of Radiation Oncology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Raymond Y Huang
- Department of Radiation Oncology, Weill Cornell Medical College, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York.,Department of Radiology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
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Lee G, Besse L, Lamba N, Hancox C, Usta I, Hacker F, Catalano P, Brown PD, Tanguturi S, Pashtan I, Phillips J, Haas-Kogan D, Alexander B, Cagney D, Aizer A. Feasibility of hippocampal avoidance whole brain radiation in patients with hippocampal involvement: Data from a prospective study. Med Dosim 2020; 46:21-28. [PMID: 32778521 DOI: 10.1016/j.meddos.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Among patients with brain metastases, hippocampal avoidance whole brain radiation (HA-WBRT) preserves neurocognitive function relative to conventional WBRT but the feasibility of hippocampal sparing in patients with metastases in/near the hippocampus is unknown. We identified the incidence of hippocampal/perihippocampal metastases and evaluated the feasibility of HA-WBRT in such patients. MATERIALS/METHODS Dosimetric data from 34 patients randomized to HA-WBRT (30 Gy/10 fractions) in a phase III trial (NCT03075072) comparing HA-WBRT to stereotactic radiation in patients with 5 to 20 brain metastases were analyzed. Patients with metastases in/near the hippocampi received HA-WBRT with prioritization of tumor coverage over hippocampal avoidance. Target coverage and hippocampal sparing metrics were compared between patients with targets in/near the hippocampus versus not. RESULTS In total, 9 of 34 (26%) patients had targets in the hippocampus and an additional 5 of 34 (15%) patients had targets in the hippocampal avoidance zone (HAZ, hippocampus plus 5 mm expansion) but outside the hippocampus. Patients with targets within the hippocampus and those with targets in the HAZ but outside the hippocampus were spared 34% and 73% of the ipsilateral mean biologically equivalent prescription dose, respectively. Of the latter cohort, 88% and 25% met conventional hippocampal sparing metrics of Dmin ≤ 9 Gy and Dmax ≤ 16 Gy, respectively. Among 11 patients with unilateral hippocampal/perihippocampal involvement, the uninvolved/contralateral hippocampus was limited to Dmin ≤ 9 Gy and Dmax ≤ 17 Gy in all cases. CONCLUSIONS In this study, a substantial percentage of patients with 5 to 20 brain metastases harbored metastases in/near the hippocampus. In such cases, minimizing hippocampal dose while providing tumor coverage was feasible and may translate to neurocognitive protection.
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Affiliation(s)
- Grace Lee
- Harvard Medical School, Boston, MA 02115, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Luke Besse
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA; Broad Institute, Cambridge, MA 02142, USA.
| | - Nayan Lamba
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Cindy Hancox
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Iquan Usta
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Fred Hacker
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Paul Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Shyam Tanguturi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Itai Pashtan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - John Phillips
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Brian Alexander
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Daniel Cagney
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Ayal Aizer
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 02115, USA.
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Impact of Early Prophylactic Cranial Irradiation With Hippocampal Avoidance on Neurocognitive Function in Patients With Limited Disease Small Cell Lung Cancer. A Multicenter Phase 2 Trial (SAKK 15/12). Int J Radiat Oncol Biol Phys 2020; 107:279-287. [DOI: 10.1016/j.ijrobp.2020.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/10/2023]
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Lin B, Huang D, Yang X, Zhang Y, Gang F, Du XB. Distribution of brain metastases: low-risk metastasis areas may be avoided when treating with whole-brain radiotherapy. Cancer Imaging 2020; 20:29. [PMID: 32321584 PMCID: PMC7178626 DOI: 10.1186/s40644-020-00309-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Previous work has demonstrated that metastases are not uniformly distributed across the brain. This study aims to determine there are low-risk brain metastasis (BM) areas that may be avoided during whole-brain radiotherapy (WBRT) to reduce neurocognitive toxicity. Methods Clinical and magnetic resonance imaging (MRI) data of 991 metastases in 192 patients with advanced cancer were analyzed retrospectively. Eleven anatomically defined regions of interest (ROIs) were contoured, and the locations of the BMs were recorded. Using the same definition, ROIs were contoured in 20 healthy volunteers.The proportions of patients with BMs in different ROIs, proportion of BMs, and proportion of different ROI volumes relative to the total volume were calculated. Results The proportion of observed BMs was lower than expected in the brainstem, insula, diencephalon and internal structures, corpus callosum, and pituitary gland. The proportion of BMs was significantly higher than expected in the parietal lobe, occipital lobe, and cerebellum. For those patients with single BM, there was very low rate of low-risk ROIs involvement (0%), with 2–4 BMs, 6–13% of the patients had low-risk ROIs involvement, with ≥5 BMs, significant (> 30%) of the patients had low-risk ROIs involvement. Conclusion The brainstem, insula, diencephalon and internal structures, corpus callosum, and pituitary gland demonstrate low risk for metastatic involvement. Involvement of low risk areas occurs in patients with more than 1 BM.
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Affiliation(s)
- Binwei Lin
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan, People's Republic of China
| | - Dan Huang
- Radiology Department, Mianyang Central Hospital, Mianyang, Sichuan, People's Republic of China
| | - Xiyue Yang
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nan Chong, People's Republic of China
| | - Yu Zhang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan, People's Republic of China
| | - Feng Gang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan, People's Republic of China
| | - Xiao Bo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan, People's Republic of China.
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Kim JS, Kim K, Jung W, Shin KH, Im SA, Kim HJ, Kim YB, Chang JS, Choi DH, Park YH, Kim DY, Kim TH, Choi BO, Lee SW, Kim S, Kwon J, Kang KM, Chung WK, Kim KS, Nam JH, Yoon WS, Kim JH, Cha J, Oh YK, Kim IA. Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16-12). Breast 2020; 49:41-47. [PMID: 31677532 PMCID: PMC7375558 DOI: 10.1016/j.breast.2019.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study evaluated the influence of prognostic factors and whole brain radiotherapy (WBRT) on overall survival (OS) of breast cancer (BC) patients with brain metastases (BM). METHODS AND MATERIALS Medical records of 730 BC patients diagnosed with BM from 2000 to 2014 at 17 institutions were retrospectively reviewed. OS was calculated from BM diagnosis. Median follow-up duration was 11.9 months (range, 0.1-126.2). RESULTS Median OS was 15.0 months (95% CI: 14.0-16.9). Patients with different BC-specific graded prognostic assessment (GPA) scores showed significant differences (p < 0.001) in OS. In multivariate analysis, histologic grade 3 (p = 0.014), presence of extracranial metastasis (p < 0.001), the number of BM (>4; p = 0.002), hormone receptor negativity (p = 0.005), HER2-negativity (p = 0.003), and shorter time interval (<30 months) between BC and BM diagnosis (p = 0.007) were associated with inferior OS. By summing the β-coefficients of variables that were prognostic in multivariate analyses, we developed a prognostic model that stratified patients into low-risk (≤0.673) and high-risk (>0.673) subgroups; the high-risk subgroup had poorer median OS (10.1 months, 95% CI: 7.9-11.9 vs. 21.9 months, 95% CI: 19.5-27.1, p < 0.001). Univariate and multivariate analyses of propensity score-matched patients diagnosed with BM ≥ 30 months after BC diagnosis (n = 389, "late BM") revealed that WBRT-treated patients showed superior OS compared to non-WBRT-treated patients (p = 0.070 and 0.030, respectively). CONCLUSION Our prognostic model identified high-risk BC patients with BM who might benefit from increased surveillance; if validated, our model could guide treatment selection for such patients. Patients with late BM might benefit from WBRT as initial local treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Brain Neoplasms/mortality
- Brain Neoplasms/radiotherapy
- Brain Neoplasms/secondary
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/secondary
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Prognosis
- Republic of Korea/epidemiology
- Retrospective Studies
- Survival Analysis
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea.
| | - Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Hee-Jun Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Republic of Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Yeon Hee Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Dae Yong Kim
- Proton Therapy Center, National Cancer Center, Republic of Korea
| | - Tae Hyun Kim
- Proton Therapy Center, National Cancer Center, Republic of Korea
| | - Byung Ock Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University College of Medicine, Republic of Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Republic of Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea; Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Republic of Korea
| | - Ji Ho Nam
- Department of Radiation Oncology, Yangsan Pusan National University Hospital, Pusan National University School of Medicine, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Republic of Korea
| | - Jihye Cha
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Republic of Korea
| | - Yoon Kyeong Oh
- Department of Radiation Oncology, Chosun University Medical School, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea.
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Lv X, He H, Yang Y, Han L, Guo Z, Chen H, Li J, Qiu Y, Xie C. Radiation-induced hippocampal atrophy in patients with nasopharyngeal carcinoma early after radiotherapy: a longitudinal MR-based hippocampal subfield analysis. Brain Imaging Behav 2020; 13:1160-1171. [PMID: 30054872 DOI: 10.1007/s11682-018-9931-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Increasing evidence indicates that radiation-induced injury to the hippocampus may play a critical role in neurocognitive dysfunction in patients with nasopharyngeal carcinoma (NPC). However, few studies have assessed RT-induced hippocampal structural alterations in these patients early after radiotherapy (RT). In this study, 58 NPC patients were longitudinally followed up prior to treatment initiation as well as 3 and 6 months after RT, respectively. Twenty comparable normal controls were recruited and followed up in parallel. A novel magnetic resonance imaging (MRI)-based automated method was used to label hippocampal subfields. The linear mixed model was employed to evaluate longitudinal changes in the volumes of the whole hippocampus and seven hippocampal subfields. Time-dependent volume reduction was observed in the bilateral hippocampus, as well as in the bilateral granule cell layer (GCL), bilateral cornu ammonis 1 (CA1), bilateral molecular layer (ML), and bilateral subiculum (SUB) in NPC patients, but not in controls. Moreover, volume deficits in the bilateral hippocampus, bilateral GCL, and right ML showed dose-dependent patterns, and high volume losses in the bilateral hippocampus, bilateral GCL, left SUB, and right ML were associated with a rapid decline in cognitive function. Our findings demonstrated that the hippocampal subfields were selectively injured by irradiation-related early neurotoxic effects, which might account for cognitive impairment in NPC patients at an early stage after RT. Further, structural MRI could serve as a potential noninvasive imaging biomarker for the early detection of radiation effects on the hippocampus in NPC patients after RT.
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Affiliation(s)
- Xiaofei Lv
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Haoqiang He
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Yadi Yang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Lujun Han
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Zheng Guo
- Department of Oncology, The First Affiliated Hospital of Ganzhou Medical University, Ganzhou, Jiangxi, People's Republic of China
| | - Hong Chen
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Jing Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Yingwei Qiu
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China.
| | - Chuanmiao Xie
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.
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Traylor JI, Patel R, Habib A, Muir M, de Almeida Bastos DC, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy to the Posterior Fossa: Challenges and Nuances. World Neurosurg 2019; 132:e124-e132. [DOI: 10.1016/j.wneu.2019.08.242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
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Tang Z, Zou X, Luo Q, Wang Y, Jin F. The Risk of Radiogenic Second Cancer Based on Differential DVH: Central Nervous System Malignant Tumor in Children. Technol Cancer Res Treat 2019; 18:1533033819886899. [PMID: 31707971 PMCID: PMC6843732 DOI: 10.1177/1533033819886899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To quantify the risk of radiogenic second cancer in pediatric patients receiving hippocampal-sparing craniospinal irradiation either with intensity-modulated radiation therapy or tomotherapy due to the development of a solid second cancer after radiotherapy using the concept of excess absolute risk. METHODS Computed tomography images of 15 pediatric patients who received craniospinal irradiation treatment were selected for this study. For each case, intensity-modulated radiation therapy and tomotherapy plans were computed. Then, the dosimetry parameters were analyzed. Differential dose-volume histograms were generated, and the excess absolute risks were calculated for each plan of each patient. RESULTS The tomotherapy group was superior to the intensity-modulated radiation therapy group in target area homogeneity index (P < .001). Tomotherapy offered greater hippocampal sparing than intensity-modulated radiation therapy in terms of D 2% (15.66 vs 23.05 Gy, P < .001) and Dmean (9.79 vs 20.29 Gy, P < .001). Tomotherapy craniospinal irradiation induced a much higher risk than intensity-modulated radiation therapy craniospinal irradiation to the thyroid and lungs (excess absolute risk: thyroid 28.7 vs 26.9 per 10 000 PY, P = .010; lung 20.5 vs 18.9 per 10 000 PY, P = .003). Both techniques conferred a higher risk to the stomach, but there was little difference. In addition, the 2 plans induced less carcinogenic risk to the liver (excess absolute risk 4.2 vs 4.0 per 10 000 PY, P = .020). CONCLUSIONS The tomotherapy plan has obvious advantages in the protection of the hippocampus for children undergoing craniospinal irradiation treatment. Tomotherapy increased the risk of radiogenic second cancer in organ at risk, and therefore, it is imperative to take the risk factor into consideration in the formulation of treatment protocols.
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Affiliation(s)
- Zheng Tang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xue Zou
- Chongqing University Cancer Hospital, Chongqing, China
| | - Qian Luo
- Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Wang
- Chongqing University Cancer Hospital, Chongqing, China.,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Fu Jin
- Chongqing University Cancer Hospital, Chongqing, China.,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
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Mampre D, Ehresman J, Alvarado-Estrada K, Wijesekera O, Sarabia-Estrada R, Quinones-Hinojosa A, Chaichana KL. Propensity for different vascular distributions and cerebral edema of intraparenchymal brain metastases from different primary cancers. J Neurooncol 2019; 143:115-122. [PMID: 30835021 DOI: 10.1007/s11060-019-03142-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE This study seeks to ascertain whether different primary tumor types have a propensity for brain metastases (BMs) in different cerebral vascular territories and cerebral edema. METHODS Consecutive adult patients who underwent surgical resection of a BM at a tertiary care institution between 2001 and 2011 were retrospectively reviewed. Only patients with the most common primary cancers (lung, breast, skin-melanoma, colon, and kidney) were included. Preoperative MRIs were reviewed to classify all tumors by cerebral vascular territory (anterior cerebral artery-ACA, lenticulostriate, middle cerebral artery-MCA, posterior cerebral artery-PCA, posterior fossa, and watershed), and T2-weighted FLAIR widths were measured. Chi square analyses were performed to determine differences in cerebral vascular distribution by primary tumor type, and one-way ANOVA analyses were performed to determine FLAIR signal differences. RESULTS 669 tumors from 388 patients were classified from lung (n = 316 BMs), breast (n = 144), melanoma (n = 119), renal (n = 47), and colon (n = 43). BMs from breast cancer were less likely to be located in PCA territory (n = 18 [13%]; χ2 = 6.10, p = 0.01). BMs from melanoma were less likely to be located in cerebellar territory (n = 11 [9%]; χ2 = 14.1, p < 0.001), and more likely to be located in lateral (n = 5 [4%]; χ2 = 4.56, p = 0.03) and medial lenticulostriate territories (n = 2 [2%]; χ2 = 6.93, p = 0.009). BMs from breast and melanoma had shorter T2-FLAIR widths, with an average [IQR] of 47.2 [19.6-69.2] mm (p = 0.01) and 41.2 [14.4-62.7] mm (p = 0.002) respectively. Conversely, BMs from renal cancer had longer T2-FLAIR widths (64.2 [43.6-80.8] mm, p = 0.002). CONCLUSIONS These findings suggest that different primary tumor types could have propensities for different cerebral vascular territories and cerebral edema.
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Affiliation(s)
- David Mampre
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Keila Alvarado-Estrada
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Olindi Wijesekera
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Rachel Sarabia-Estrada
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Sun Q, Li M, Wang G, Xu H, He Z, Zhou Y, Zhou Y, Zhou Y, Song H, Jiang H. Distribution of metastasis in the brain in relation to the hippocampus: a retrospective single-center analysis of 565 metastases in 116 patients. Cancer Imaging 2019; 19:2. [PMID: 30670096 PMCID: PMC6341547 DOI: 10.1186/s40644-019-0188-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/16/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To examine the distribution of brain metastases (BM) in relation to the hippocampus, so as to determine the risk of metastasis in the hippocampus, and thus provide experimental evidence for the hippocampal avoidance (HA) in patients with BM during radiotherapy. METHODS (1) For the retrospective analysis of 116 patients diagnosed with malignancies, confirmed as BM, from December 2014 to December 2016 at the First Affiliated Hospital of Bengbu Medical College. We obtained the T1-weighted, postcontrast axial, sagittal, and coronal Magnetic Resonance imaging (MRI) images f the patients, in supine position, using the head restraints and head thermoplastic masks to adjust the positioning, with computed tomography (CT) positioning scan ranging from the head to the mandible (layer thickness: 3 mm). CT and MRI images were fused on a Philips Pinnacle v9.8 treatment planning system;(2) Every metastasis of the 565 metastases was contoured;(3) hippocampus were contoured, and hippocampus with 5 mm expansion envelopes were analyzed;(4) Using the SPSS 16.0 software, we analyzed the relation between the distribution and age, sex, Karnofsky performance status (KPS), primary site, aggregate volume of intracranial metastases and the whole brain. The data were analyzed using a binary logistic regression analysis method, with two-sided P < 0.05 for statistical significance. RESULTS In this study, we recruited 116 patients with 565 metastases. Among them, 1.7% (n = 2) had metastases in the hippocampus, and 11.2% (n = 13) had metastases within 5 mm of the hippocampus, of which more than half were patients with non-small cell lung cancer (n = 7). Using a binary logistic regression to analyze the relation between the metastases located within 5 mm of the hippocampus and age (P = 0.395), sex (P = 0.139), KPS (P = 0.724), primary site (P = 0.894), aggregate volume of intracranial metastases (p = 0.093) and the whole brain (p = 0.998), and none of them showed statistically significant difference between them and the metastases location (P>0.05). CONCLUSION This study showed a low risk for the perihippocampal metastases (PHM) and no significant correlation between PHM and age, sex, KPS, primary site, aggregate volume of intracranial metastases and the whole brain. Accordingly, it is may be acceptable to avoid the perihippocampal region during whole brain radiotherapy.
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Affiliation(s)
- Qian Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Min Li
- Department of Pharmacy, Bengbu Medical College, Bengbu, 233004 China
| | - Gengming Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Hongbo Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Zelai He
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Yongchun Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Yan Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Yufu Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Hongwei Song
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
| | - Hao Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004 China
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Fatigue following radiation therapy in nasopharyngeal cancer survivors: A dosimetric analysis incorporating patient report and observer rating. Radiother Oncol 2019; 133:35-42. [PMID: 30935579 DOI: 10.1016/j.radonc.2018.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE To explore for fatigue-related regions and the radiotherapy (RT) dose-fatigue relationship in nasopharyngeal cancer (NPC) survivors. METHODS Eighty disease-free NPC survivors completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN) after RT. Fatigue was evaluated by the MDASI-HN fatigue item (MDASI-HN-F) and Common Terminology Criteria for Adverse Events v3.0 (CTC-AE), between 6 and 36 months after RT to determine the presence of chronic fatigue. Skull base MRIs and planning CT/RT dose were retrievable for 56 patients. Dosimetric data were extracted for 10 MRI-defined potential fatigue at-risk structures (FARS): brainstem (BS), pituitary gland (PG), hypothalamus (HT), basal ganglia, internal capsule, pineal gland, sub-thalamic nuclei, thalamus, substantia nigra, and hippocampus (HC). Recursive partitioning analysis (RPA) was used to identify dose-volume effects associated with chronic fatigue. RESULTS 56 pts formed the cohort. Thirty patients (54%) reported any fatigue per MDASI-HN-F. Thirty-three pts (59%) had any fatigue by CTC-AE. The maximum point doses (Dmax) for PG, BS, HC, and HT were numerically higher in patients with fatigue. Dmax and Dmean of the PG were significantly higher in patients with chronic fatigue, p ≤ 0.01. A dose-volume threshold of PG V52 Gy ≥16% (LogWorth 2.4, AUC 0.7) was identified on RPA, and potential sensitivity to the PG doses was observed in younger patients (<53 years-old). CONCLUSION A dose-fatigue relationship was identified for the pituitary gland, both patient-reported and observer ratings. We recommend limiting the Dmax of PG to <54 Gy and V52 Gy to <16%, particularly in young NPC patients, during plan optimization when achievable.
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Prado A, Milanés AI, Cabello E, Díaz R, Ferrando A, Pozo G, Leonor M, Manzano M. Dosimetric Comparison of Four Volumetric-Modulated Arc Therapy Beam Arrangements Utilized for Hippocampal-Sparing Whole-Brain Radiation Therapy. J Med Phys 2019; 44:1-8. [PMID: 30983764 PMCID: PMC6438050 DOI: 10.4103/jmp.jmp_56_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In the present study, the performance of four VMAT beam arrangements used for hippocampal-sparing whole-brain radiation therapy is addressed. MATERIAL AND METHODS Data corresponding to 20 patients were utilized so as to generate plans for every beam configuration. A preliminary study was conducted to assess the optimal distance between optimization structures (PTVx) and hippocampi. V25, V30, D50%, D2%, D98%, homogeneity index (HI) and Paddick conformity factor (CF) were evaluated for PTV. D100% and Dmax were considered for hippocampi. All plans were required to perform at least as recommended in RTOG 0933 trial regarding organs at risk (OAR) sparing and PTV objectives. RESULTS Considerable hippocampi sparing alongside with a reasonably low decrease in PTV coverage was achieved using a 7 mm distance between hippocampi and PTV optimization structure. Beam setup 3 (comprised of two full arcs with 0° couch angle and two half arcs with 90° couch angle) achieved the best PTV coverage, HI and CF, while it performed the second-best sparing in hippocampi and lenses. Moreover, beam setup 3 was the second-fastest treatment, although it resulted in the highest number of delivered MU among all beam setups. Beam setup 1 (comprised of two full arcs with no couch angles) was the fastest and it delivered a significantly less amount of monitor units compared with the other beam setups evaluated. Furthermore, a higher robustness was obtained by using no couch angles. Although beam setup 1 was the least optimal considering OAR sparing, it still performed better than required in the RTOG 0933 trial. CONCLUSIONS Overall, beam setup 3 was considered to be the best. It is worth mentioning that, apart from our results, the election of one of these beam arrangements might be dependent on the amount of patient workload at a specific institution.
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Affiliation(s)
- Alejandro Prado
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Ana Isabel Milanés
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Eduardo Cabello
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Raúl Díaz
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Alejandro Ferrando
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Gustavo Pozo
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Mario Leonor
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
| | - Marta Manzano
- Department of Medical Physics and Radiation Protection, University Hospital 12 de Octubre, Madrid, Spain
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Incidence of Hippocampal Metastases: Laterality and Implications for Unilateral Hippocampal Avoiding Whole Brain Radiotherapy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2459608. [PMID: 30643795 PMCID: PMC6311293 DOI: 10.1155/2018/2459608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/04/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022]
Abstract
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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Abstract
The incidence of brain metastases is projected to rise because survival rates of lung cancer, breast cancer, and melanoma continue to improve (1). The brain is being identified as a sanctuary site for harboring metastases despite excellent control of extracranial disease. This is thought to occur because the drug therapies that control extracranial disease have limited central nervous system (CNS) penetration. The development of brain metastases is a devastating diagnosis affecting both quality of life (QOL) and survival. Symptoms after diagnosis can include headache, nausea, vomiting, seizure, neurocognitive decline, and focal neurologic deficit. Some of these symptoms can be irreversible even after successful treatment of intracranial disease. Treatment of brain metastases often necessitates surgery and radiation. There have been some reports of systemic therapies offering an intracranial response however long-term data is lacking. These treatments for CNS metastases can also lead to neurocognitive sequelae impacting quality of life. Therefore, preventing disease from spreading to the brain is a topic that has generated much interest in oncology. Prophylactic cranial Irradiation (PCI) has been used in leukemia, small cell lung cancer (SCLC), and non-small cell lung cancer (NSCLC). While showing effectiveness in preventing intracranial disease development, its carries with it side effects of neurocognitive decline that can affect QOL. There are Clinical trials exploring novel delivery of PCI and concurrent neuroprotective drug therapy to try to mitigate these neurocognitive sequelae. These will be important trials to complete, as PCI has shown promise in controlling disease and prolonging survival in select patient populations. There are also drug therapies that have shown efficacy in preventing CNS metastases development. This review will explore the current therapies available to prevent CNS metastases.
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Affiliation(s)
- Joseph A Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
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Roux A, Botella C, Still M, Zanello M, Dhermain F, Metellus P, Pallud J. Posterior Fossa Metastasis-Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery. World Neurosurg 2018; 117:271-279. [PMID: 29935321 DOI: 10.1016/j.wneu.2018.06.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is no consensus concerning the management of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus, especially regarding surgical procedures. A literature review was performed to assess the surgical strategy in the management of patients with metastatic brain tumor. METHODS A literature search was conducted of PubMed in November 2017 to identify all studies concerning brain metastases and obstructive hydrocephalus in English. All studies (except case reports and pediatric studies) between December 1953 and November 2017 that were about posterior fossa metastasis-associated obstructive hydrocephalus in adult patients were eligible. Eligible studies were classified by level of evidence. We assessed epidemiology, clinical and imaging findings, neurosurgical management, and prognosis of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus. We suggest some practical considerations and a management decision tree on behalf of the Neuro-oncology Club of the French Society of Neurosurgery, with evidence-based analysis. RESULTS Direct surgical resection could be considered for patients with asymptomatic obstructive hydrocephalus, and endoscopic third ventriculostomy seems to be a reasonable procedure for patients with symptomatic obstructive hydrocephalus. A ventriculoperitoneal or atrial shunt seems to be a valid alternative when patients have a history of central nervous system infection or ventricular hemorrhage, leptomeningeal carcinomatosis, or unfavorable anatomy for an endoscopic third ventriculostomy to be performed. CONCLUSIONS The Neuro-oncology Club of the French Society of Neurosurgery suggests a prospective assessment of these neurosurgical procedures to compare their safety and efficacy.
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Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Céline Botella
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Henri-Mondor Hospital, Créteil, France
| | - Megan Still
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Ramsay-Générale de Santé, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
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Calluaud G, Terrier LM, Mathon B, Destrieux C, Velut S, François P, Zemmoura I, Amelot A. Peritumoral Edema/Tumor Volume Ratio: A Strong Survival Predictor for Posterior Fossa Metastases. Neurosurgery 2018; 85:117-125. [DOI: 10.1093/neuros/nyy222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/04/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - Louis-Marie Terrier
- CHRU de Tours, Department of Neurosurgery, Tours, France
- Université François-Rabelais de Tours, Inserm, iBrain, UMR U1253, Tours, France
| | - Bertrand Mathon
- CHU La Pitié-Salpétrière, Department of Neurosurgery, Paris, France
| | - Christophe Destrieux
- CHRU de Tours, Department of Neurosurgery, Tours, France
- Université François-Rabelais de Tours, Inserm, iBrain, UMR U1253, Tours, France
| | - Stéphane Velut
- CHRU de Tours, Department of Neurosurgery, Tours, France
- Université François-Rabelais de Tours, Inserm, iBrain, UMR U1253, Tours, France
| | | | - Ilyess Zemmoura
- CHRU de Tours, Department of Neurosurgery, Tours, France
- Université François-Rabelais de Tours, Inserm, iBrain, UMR U1253, Tours, France
| | - Aymeric Amelot
- CHRU de Tours, Department of Neurosurgery, Tours, France
- CHU La Pitié-Salpétrière, Department of Neurosurgery, Paris, France
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Bartel F, van Herk M, Vrenken H, Vandaele F, Sunaert S, de Jaeger K, Dollekamp NJ, Carbaat C, Lamers E, Dieleman EMT, Lievens Y, de Ruysscher D, Schagen SB, de Ruiter MB, de Munck JC, Belderbos J. Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation. Clin Transl Oncol 2018; 21:178-186. [PMID: 29876759 DOI: 10.1007/s12094-018-1903-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/24/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) techniques have been developed to reduce radiation damage to the hippocampus. An inter-observer hippocampus delineation analysis was performed and the influence of the delineation variability on dose to the hippocampus was studied. MATERIALS AND METHODS For five patients, seven observers delineated both hippocampi on brain MRI. The intra-class correlation (ICC) with absolute agreement and the generalized conformity index (CIgen) were computed. Median surfaces over all observers' delineations were created for each patient and regional outlining differences were analysed. HA-PCI dose plans were made from the median surfaces and we investigated whether dose constraints in the hippocampus could be met for all delineations. RESULTS The ICC for the left and right hippocampus was 0.56 and 0.69, respectively, while the CIgen ranged from 0.55 to 0.70. The posterior and anterior-medial hippocampal regions had most variation with SDs ranging from approximately 1 to 2.5 mm. The mean dose (Dmean) constraint was met for all delineations, but for the dose received by 1% of the hippocampal volume (D1%) violations were observed. CONCLUSION The relatively low ICC and CIgen indicate that delineation variability among observers for both left and right hippocampus was large. The posterior and anterior-medial border have the largest delineation inaccuracy. The hippocampus Dmean constraint was not violated.
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Affiliation(s)
- F Bartel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M van Herk
- Department of Cancer Sciences, University of Manchester, Manchester, UK
| | - H Vrenken
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - F Vandaele
- Department of Radiotherapy, Iridium Cancer Network, Antwerp, Belgium
| | - S Sunaert
- Department of Radiology, University Hospitals Leuven, Louvain, Belgium
| | - K de Jaeger
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | - N J Dollekamp
- Department of Radiotherapy, The University Medical Center Groningen, Groningen, The Netherlands
| | - C Carbaat
- Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E Lamers
- Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E M T Dieleman
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - D de Ruysscher
- Department of Radiotherapy, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J C de Munck
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - J Belderbos
- Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Sinclair G, Benmakhlouf H, Martin H, Brigui M, Maeurer M, Dodoo E. The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases. Surg Neurol Int 2018; 9:112. [PMID: 29930878 PMCID: PMC5991270 DOI: 10.4103/sni.sni_387_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/26/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Approximately 20–30% of all intracranial metastases are located in the posterior fossa. The clinical evolution hinges on factors such as tumor growth dynamics, local topographic conditions, performance status, and prompt intervention. Fourth ventricle (V4) compression with secondary life-threatening obstructive hydrocephalus remains a major concern, often requiring acute surgical intervention. We have previously reported on the application of adaptive hypofractionated Gamma Knife Radiosurgery in the acute management of critically located metastases, a technique known to us as rapid rescue radiosurgery (3R). We report the results of 3R in the management of posterior fossa lesions and ensuing V4 decompression. Case Descriptions: Four patients with V4 compression due to posterior fossa metastases were treated with 3R by three separate gamma knife radiosurgical sessions (GKRS) over a period of seven days. Mean V4 volume was 1.02 cm3 at GKRS 1, 1.13 cm3 at GKRS 2, and 1.12 cm3 at GKRS 3. Mean tumor volume during the week of treatment was 10 cm3 at both GKRS 1 and 2 and 9 cm3 at GKRS 3. On average, we achieved a tumor volume reduction of 52% and a V4 size increase of 64% at the first follow-up (4 weeks after GKRS 3). Long-term follow-up showed continued local tumor control, stable V4 volume, and absence of hydrocephalus. Conclusion: For this series, 3R was effective in terms of rapid tumor ablation, V4 decompression, and limited radiation-induced toxicity. This surgical procedure may become an additional tool in the management of intractable posterior fossa metastasis with V4 compression.
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Affiliation(s)
- G Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - H Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - H Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Brigui
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - E Dodoo
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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48
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Franchino F, Rudà R, Soffietti R. Mechanisms and Therapy for Cancer Metastasis to the Brain. Front Oncol 2018; 8:161. [PMID: 29881714 PMCID: PMC5976742 DOI: 10.3389/fonc.2018.00161] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Advances in chemotherapy and targeted therapies have improved survival in cancer patients with an increase of the incidence of newly diagnosed brain metastases (BMs). Intracranial metastases are symptomatic in 60–70% of patients. Magnetic resonance imaging (MRI) with gadolinium is more sensitive than computed tomography and advanced neuroimaging techniques have been increasingly used in the detection, treatment planning, and follow-up of BM. Apart from the morphological analysis, the most effective tool for characterizing BM is immunohistochemistry. Molecular alterations not always reflect those of the primary tumor. More sophisticated methods of tumor analysis detecting circulating biomarkers in fluids (liquid biopsy), including circulating DNA, circulating tumor cells, and extracellular vesicles, containing tumor DNA and macromolecules (microRNA), have shown promise regarding tumor treatment response and progression. The choice of therapeutic approaches is guided by prognostic scores (Recursive Partitioning Analysis and diagnostic-specific Graded Prognostic Assessment-DS-GPA). The survival benefit of surgical resection seems limited to the subgroup of patients with controlled systemic disease and good performance status. Leptomeningeal disease (LMD) can be a complication, especially in posterior fossa metastases undergoing a “piecemeal” resection. Radiosurgery of the resection cavity may offer comparable survival and local control as postoperative whole-brain radiotherapy (WBRT). WBRT alone is now the treatment of choice only for patients with single or multiple BMs not amenable to surgery or radiosurgery, or with poor prognostic factors. To reduce the neurocognitive sequelae of WBRT intensity modulated radiotherapy with hippocampal sparing, and pharmacological approaches (memantine and donepezil) have been investigated. In the last decade, a multitude of molecular abnormalities have been discovered. Approximately 33% of patients with non-small cell lung cancer (NSCLC) tumors and epidermal growth factor receptor mutations develop BMs, which are targetable with different generations of tyrosine kinase inhibitors (TKIs: gefitinib, erlotinib, afatinib, icotinib, and osimertinib). Other “druggable” alterations seen in up to 5% of NSCLC patients are the rearrangements of the “anaplastic lymphoma kinase” gene TKI (crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib). In human epidermal growth factor receptor 2-positive, breast cancer targeted therapies have been widely used (trastuzumab, trastuzumab-emtansine, lapatinib-capecitabine, and neratinib). Novel targeted and immunotherapeutic agents have also revolutionized the systemic management of melanoma (ipilimumab, nivolumab, pembrolizumab, and BRAF inhibitors dabrafenib and vemurafenib).
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Affiliation(s)
- Federica Franchino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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49
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Di Carlo C, Trignani M, Caravatta L, Vinciguerra A, Augurio A, Perrotti F, Di Tommaso M, Nuzzo M, Giancaterino S, Falco MD, Genovesi D. Hippocampal sparing in stereotactic radiotherapy for brain metastases: To contour or not contour the hippocampus? Cancer Radiother 2018; 22:120-125. [PMID: 29576492 DOI: 10.1016/j.canrad.2017.08.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/23/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of our study was to evaluate hippocampal irradiation in patients treated with fractionated stereotactic brain radiotherapy. PATIENTS AND METHODS Retrospective hippocampal dosimetric analysis performed on 22 patients with one to four brain metastases treated with fractionated stereotactic radiotherapy using volumetric intensity-modulated arc therapy. Original plans did not include hippocampus as avoidance structure in optimization criteria; hippocampus was retrospectively delineated on magnetic resonance coregistered with planning CT and using as reference the RTOG 0933 atlas. Hippocampus was defined both as a single and as pair organ. Constraints analysed were: Dmax<16Gy, D40%<7.3Gy, D100%=Dmin<9Gy. Assuming a α/β ratio of 2Gy, biologically equivalent dose in 2Gy fractions was calculated. Hippocampal-sparing plans were developed in cases where hippocampal constraints were not respected in the original plan. RESULTS Among constraints analysed Dmax and D40% have been exceeded in ten out of 22 cases. The constraints were not respected in patients with more than one metastatic lesion and in three patients with only one lesion. Considering all exceeded constraints values in non-hippocampal sparing plans, the 50% of them was respected after replanning. No significant differences were found among conformity and homogeneity index between non-hippocampal sparing and hippocampal sparing plans. CONCLUSION Volumetric intensity-modulated arc therapy hippocampal sparing plans significantly decreases dose to hippocampus assuring an equal target coverage and organs at risk avoiding.
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Affiliation(s)
- C Di Carlo
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - M Trignani
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - L Caravatta
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - A Vinciguerra
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - A Augurio
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - F Perrotti
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - M Di Tommaso
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - M Nuzzo
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - S Giancaterino
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - M D Falco
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - D Genovesi
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy.
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50
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Zhang I, Antone J, Li J, Saha S, Riegel AC, Vijeh L, Lauritano J, Marrero M, Salas S, Schulder M, Zinkin H, Goenka A, Knisely J. Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery. Pract Radiat Oncol 2018; 7:183-189. [PMID: 28477798 DOI: 10.1016/j.prro.2017.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Our purpose was to evaluate hippocampal doses and target volume coverage with and without hippocampal sparing when treating multiple brain metastases using various stereotactic radiosurgery (SRS) platforms. METHODS AND MATERIALS We selected 10 consecutive patients with 14 separate treatments who had been treated in our department for 3 to 10 brain metastases and added hippocampal avoidance contours. All 14 treatments were planned with GammaPlan for Gamma Knife, Eclipse for single isocenter volumetric modulated arc therapy (VMAT), TomoTherapy Treatment Planning System (TPS) for TomoTherapy, and MultiPlan for CyberKnife. Initial planning was performed with the goal of planning target volume coverage of V100 ≥95% without hippocampal avoidance. If the maximum hippocampal point dose (Dmax) was <6.6 Gy in a single fraction and <40% of the hippocampi received ≤4.5 Gy, no second plan was performed. If either constraint was not met, replanning was performed with these constraints. RESULTS There was a median of 6 metastases per plan, with an average total tumor volume of 7.32 mL per plan. The median hippocampal Dmax (in Gy) without sparing averaged 1.65, 9.81, 4.38, and 5.46, respectively (P < .0001). Of 14 plans, 3 Gamma Knife and CyberKnife plans required replanning, whereas 13 VMAT and 8 TomoTherapy plans required replanning. The hippocampal constraints were not achievable in 1 plan on any platform when the tumor was bordering the hippocampus. The mean volume of brain receiving 12 Gy (in mL), which has been associated with symptomatic radionecrosis, was 23.57 with Gamma Knife, 76.77 with VMAT, 40.86 with CyberKnife, and 104.06 with TomoTherapy (P = .01). The overall average conformity indices for all plans ranged from 0.36 to 0.52. CONCLUSIONS Even with SRS, the hippocampi can receive a considerable dose; however, if the hippocampi are outlined as organs of risk, sparing these structures is feasible in nearly all situations with all 4 platforms, without detriment to target coverage, and should be considered in all patients undergoing SRS for multiple brain metastases. SUMMARY Hippocampi play an important role in memory, and sparing of these structures in whole brain radiation can improve neurocognitive outcomes. The hippocampi are not routinely spared when using stereotactic radiosurgery. We evaluated the incidental dose to the hippocampi when treating multiple brain metastases and sought to examine if hippocampal sparing is feasible without detriment to target coverage. We found that hippocampal sparing is possible without affecting coverage or conformality in most cases across treatment platforms.
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Affiliation(s)
- Isabella Zhang
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York.
| | - Jeff Antone
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Jenny Li
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Shyamali Saha
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Adam C Riegel
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Lili Vijeh
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Joe Lauritano
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Mihaela Marrero
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Sussan Salas
- Department of Neurosurgery, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Michael Schulder
- Department of Neurosurgery, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Heather Zinkin
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Anuj Goenka
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
| | - Jonathan Knisely
- Department of Radiation Medicine, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, New York
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