Research progress on hippocampal-avoidance whole brain radiotherapy
Chen Mengyuan, Chen Yuanyuan, Chen Ming, Du Xianghui
Institute of Cancer and Basic Medicine and Chinese Academy of Sciences, Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310000, China
Abstract：With the advancement of imaging diagnosis and the development of modern radiotherapy, the survival of cancer patients has been prolonged and the incidence rate of brain metastases (BM) has been significantly increased. The quality of life of patients and potential radiotherapy-induced neurocognitive impairment have gradually captivated widespread attention. Whole brain radiotherapy (WBRT) is one of the common local therapies for BM patients. However,the application of WBRT is controversial because it may lead to neurocognitive impairment. The incidence of metastatic tumors in hippocampus and radiation-induced neurocognitive impairment can accelerate the implementation of hippocampal-avoidance WBRT (HA-WBRT). In this article, the feasibility of HA-WBRT was discussed and research progress in recent years was reviewed.
Chen Mengyuan,Chen Yuanyuan,Chen Ming et al. Research progress on hippocampal-avoidance whole brain radiotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(7): 735-738.
[1] Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014[J]. CA Cancer J Clin, 2014, 64(1):9-29. DOI:10.3322/caac.21208. [2] Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System[J]. J Clin Oncol, 2004, 22(14):2865-2872. DOI:10.1200/JCO.2004.12.149. [3] Shi Y, Au JS, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER)[J]. J Thorac Oncol, 2014, 9(2):154-162. DOI:10.1097/JTO.0000000000000033. [4] Ge M, Zhuang Y, Zhou X, et al. High probability and frequency of EGFR mutations in non-small cell lung cancer with brain metastases[J]. J Neurooncol, 2017, 135(2):413-418. DOI:10.1007/s11060-017-2590-x. [5] Berghoff AS, Preusser M. New developments in brain metastases[J]. Ther Adv Neurol Disord, 2018, 11:1756286418785502. DOI:10.1177/1756286418785502. [6] DeAngelis LM, Delattre JY, Posner JB. Radiation-induced dementia in patients cured of brain metastases[J]. Neurology, 1989, 39(6):789-796. DOI:10.1212/wnl.39.6.789. [7] Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation:a randomised controlled trial[J]. Lancet Oncol, 2009, 10(11):1037-1044. DOI:10.1016/S1470-2045(09)70263-3. [8] Welzel G, Fleckenstein K, Schaefer J, et al. Memory function before and after whole brain radiotherapy in patients with and without brain metastases[J]. Int J Radiat Oncol Biol Phys, 2008, 72(5):1311-1318. DOI:10.1016/j.ijrobp.2008.03.009. [9] Soffietti R, Abacioglu U, Baumert B, et al. Diagnosis and treatment of brain metastases from solid tumors:guidelines from the European Association of Neuro-Oncology (EANO)[J]. Neuro Oncol, 2017, 19(2):162-174. DOI:10.1093/neuonc/now241. [10] Yamamoto M, Serizawa T, Shuto T, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901):a multi-institutional prospective observational study[J]. Lancet Oncol, 2014, 15(4):387-395. DOI:10.1016/S1470-2045(14)70061-0. [11] Yamamoto M, Serizawa T, Higuchi Y, et al. A multi-institutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901study update):irradiation-related complications and long-term maintenance of mini-mental state examination scores[J]. Int J Radiat Oncol Biol Phys, 2017, 99(1):31-40. DOI:10.1016/j.ijrobp.2017.04.037. [12] Soliman H, Das S, Larson DA, et al. Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases[J]. Oncotarget, 2016, 7(11):12318-12330. DOI:10.18632/oncotarget.7131. [13] Aoyama H, Tago M, Shirato H. Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases:secondary analysis of the JROSG 99-1 randomized clinical trial[J]. JAMA Oncol, 2015, 1(4):457-464. DOI:10.1001/jamaoncol.2015.1145. [14] Peters S, Bexelius C, Munk V, et al. The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer[J]. Cancer Treat Rev, 2016, 45:139-162. DOI:10.1016/j.ctrv.2016.03.009. [15] Fike JR, Rosi S, Limoli CL. Neural precursor cells and central nervous system radiation sensitivity[J]. Semin Radiat Oncol, 2009, 19(2):122-132. DOI:10.1016/j.semradonc.2008.12.003. [16] Barani IJ, Benedict SH, Lin PS. Neural stem cells:implications for the conventional radiotherapy of central nervous system malignancies[J]. Int J Radiat Oncol Biol Phys, 2007, 68(2):324-333. DOI:10.1016/j.ijrobp.2007.01.033. [17] Ghia A, Tomé WA, Thomas S, et al. Distribution of brain metastases in relation to the hippocampus:implications for neurocognitive functional preservation[J]. Int J Radiat Oncol Biol Phys, 2007, 68(4):971-977. DOI:10.1016/j.ijrobp.2007.02.016. [18] Kundapur V, Ellchuk T, Ahmed S, et al. Risk of hippocampal metastases in small cell lung cancer patients at presentation and after cranial irradiationa safety profilestudy for hippocampal sparing during prophylactic or therapeutic cranial irradiation[J]. Int J Radiat Oncol Biol Phys, 2015, 91(4):781-786. DOI:10.1016/j.ijrobp.2014.12.026. [19] Gondi V, Tome WA, Marsh J, et al. Estimated risk of peri-hippocampal disease progression after hippocampal avoidance during whole-brain radiotherapysafety profile for RTOG 0933[J]. Radiother Oncol, 2010, 95(3):327-331. DOI:10.1016/j.radonc.2010.02.030. [20] Marsh JC, Herskovic AM, Gielda BT, et al. Intracranial metastaticdisease spares the limbic circuit:a review of 697 metastatic lesions in107 patients[J]. Int J Radiat Oncol Biol Phys, 2010, 76(2):504-512. DOI:10.1016/j.ijrobp.2009.02.038. [21] Wan JF, Zhang SJ, Wang L, et al. Implications for preserving neural stem cells in whole brain radiotherapy and prophylactic cranial irradiation:a review of 2270 metastases in 488 patients[J]. J RadiatRes, 2013, 54(2):285-291. DOI:10.1093/jrr/rrs085. [22] Hsu F, Carolan H, Nichol A, et al. Whole brain radiotherapy with hippocampal avoidance and simultaneous integrated boost for 1-3 brain metastases:a feasibility study using volumetric modulated arc therapy[J]. Int J Radiat Oncol Biol Phys, 2010, 76(5):1480-1485. DOI:10.1016/j.ijrobp.2009.03.032. [23] Awad R, Fogarty G, Hong A, et al. Hippocampal avoidance with volumetric modulated arc therapy in melanoma brain metastases-the first Australian experience[J]. Radiat Oncol, 2013, 8:62. DOI:10.1186/1748-717X-8-62. [24] Lagerwaard FJ, van der Hoorn EA, Verbakel WF, et al. Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy[J]. Int J Radiat Oncol Biol Phys, 2009, 75(1):253-259. DOI:10.1016/j.ijrobp.2009.03.029. [25] Gutiérrez AN, Westerly DC, Tomé WA, et al. Whole brain radiotherapy with hippocampal avoidance and simultaneously integrated brain metastases boost:a planning study[J]. Int J Radiat Oncol Biol Phys, 2007, 69(2):589-597. DOI:10.1016/j.ijrobp.2007.05.038. [26] Rodrigues G, Yartsev S, Yaremko B, et al. Phase I trial of simultaneous in-field boost with helical tomotherapy for patients with one to three brain metastases[J]. Int J Radiat Oncol Biol Phys, 2011, 80(4):1128-1133. DOI:10.1016/j.ijrobp.2010.03.047. [27] Rodrigues G, Yartsev S, Tay KY, et al. A phase Ⅱ multi-institutional study assessing simultaneous in-field boost helical tomotherapy for 1-3 brain metastases[J]. Radiat Oncol, 2012, 7:42. DOI:10.1186/1748-717X-7-42. [28] Kim KH, Cho BC, Lee CG, et al. Hippocampus-sparing whole-brain radiotherapy and simultaneous integrated boost for multiple brain metastases from lung adenocarcinoma:early response and dosimetric evaluation[J]. Technol Cancer Res Treat, 2016, 15(1):122-129. DOI:10.1177/1533034614566993. [29] Prokic V, Wiedenmann N, Fels F, et al. Whole brain irradiation with hippocampal sparing and dose escalation on multiple brain metastases:a planning study on treatment concepts[J]. Int J Radiat Oncol Biol Phys, 2013, 85(1):264-270. DOI:10.1016/j.ijrobp.2012.02.036. [30] Gondi V, Pugh SL, Tome WA, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933):a phase Ⅱ multi-institutional trial[J]. J Clin Oncol, 2014, 32(34):3810-3816. DOI:10.1200/JCO.2014.57.2909. [31] Redmond KJ, Hales RK, Anderson-Keightly H, et al. Prospective study of hippocampal-sparing prophylactic cranial irradiation in limited stage small cell lung cancer[J]. Int J Radiat On-col BiolPhys, 2017,98(3):603-611. DOI:10.1016/j.ijrobp.2017.03.009. [32] Lin SY, Yang CC, Wu YM, et al. Evaluating the impact of hippocampal-sparing during whole brain radiotherapy on neurocognitive functions:a preliminary report of a pro-spectivephaseⅡstudy[J]. Biomed J, 2015, 38(5):439-449. DOI:10.4103/2319-4170.157440. [33] Gondi V, Cui Y, Mehta MP, et al. Real-time pretreatment review limits unacceptable deviations on a cooperative group radiation therapy technique trial:quality assurance results of RTOG 0933[J]. Int J Radiat Oncol Biol Phys, 2015, 91(3):564-570. DOI:10.1016/j.ijrobp.2014.10.054.
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