[an error occurred while processing this directive] | [an error occurred while processing this directive]
Phase Ⅱ clinical trial of hippocampal-sparing prophylactic cranial irradiation in patients with small cell lung cancer
Dong Xin, Zhou Zongmei, Liu Xuan, Wang Wenqing, Xiao Zefen, Zhang Tao, Wang Xin, Feng Qinfu, Bi Nan, Zhai Yirui, Liang Jun, Deng Lei, Chen Dongfu, Li Tao, Hui Zhouguang, Wang Xiaozhen, Lv Jima, Wang Lvhua, Li Yexiong
Department of Radiation Oncology,National Cancer Centre/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021,China
AbstractObjective To evaluate the dose distribution and clinical efficacy of hippocampal-sparing prophylactic cranial irradiation (HS-PCI) in patients with small cell lung cancer by using helical tomotherapy. Methods Clinical data of 49 patients with small cell lung cancer receiving HS-PCI using helical tomotherapy in Cancer Hospital between 2014 and 2017 were retrospectively analyzed. All patients received brain MRI to exclude the possibility of brain metastasis within 1 month after standard surgery or radio-and chemo-therapy. The prescription dose was 95% PTV,25 Gy in 10 fractions. The adverse reactions and cognitive functions of patients were observed before,6 months and 1 year after treatment,and the dose distribution in the hippocampal gyrus,survival rate and brain metastasis rate were analyzed. Results The median follow-up time was 16 months. The average dose in the hippocampal gyrus was 7.23 Gy and 8.46 Gy in the reduction region,which was reduced by 71.88% and 66.16% compared with the prescription dose. The maximum dose in the hippocampal gyrus was 10.66 Gy and 15.43 Gy in the reduction region. Among 49 patients,8 died,the 1-year survival rate was 85.1% and the 2-year survival rate was 70.3%.Nine patients (18.3%) had brain metastases,and one of them with extensive multiple brain metastases (n=13) presented with metastasis adjacent to the hippocampal gyrus. The main adverse reactions included mild headache,dizziness and brain edema,whereas no ≥ grade 2 adverse reactions occurred. At 6 months after treatment,the HVLT-R score was significantly decreased,and declined by 6.78% at 12 months after treatment. The HVLT-R scores did not significantly differ in patients without brain metastasis before and 12 months after treatment (P>0.05). Conclusion Application of HS-PCI using helical tomotherapy meets the dose requirement,effectively protects the cognitive function and yields slight adverse reactions.
Dong Xin,Zhou Zongmei,Liu Xuan et al. Phase Ⅱ clinical trial of hippocampal-sparing prophylactic cranial irradiation in patients with small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(7): 638-642.
Dong Xin,Zhou Zongmei,Liu Xuan et al. Phase Ⅱ clinical trial of hippocampal-sparing prophylactic cranial irradiation in patients with small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(7): 638-642.
[1] Gondi V,Tomé WA,Mehta MP.Why avoid the hippocampus? A comprehensive review[J].Radiother Oncol,2010,97(3):370-376.DOI:10.1016/j.radonc.2010.09.013. [2] 董昕,周宗玫,苗俊杰,等.局限期小细胞肺癌全脑预防照射保护海马回区的初步临床研究[J].中华放射肿瘤学杂志,2015,24(2):131-136.DOI:10.3760/cma.j.issn.1004-4221.2015.02.007. [3] Wolfson AH,Bae K,Komaki R,et al. Primary analysis of a phase Ⅱ randomized trial Radiation Therapy Oncology Group (RTOG) 0212:impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-diseases[J].Int J Radiat Oncol Biol Phys,2011,81(1):77-84.DOI:10.1016/j.ijrobp.2010.05.013. [4] 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. [5] Marsh J C,Herskovic A M,Gielda B T,et al. Intracranial metastatic disease spares the limbic circuit:a review of 697 metastatic lesions in 107 patients.[J].Int J Radiat Oncol Biol Phys,2010,76(2):504-512.DOI:10.1016/j.ijrobp.2009.02.038. [6] Gondi V,Pugh S L,Tome W A,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. [7] 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 Oncol Biol Phys,2016,96(2):S57-S57.DOI:10.1016/j.ijrobp.2017.03.009. [8] Kundapur V,Ellchuk T,Ahmed S,et al. Risk of hippocampal metastases in small cell lung cancer patients at presentation and after cranial irradiation:a safety profile study 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. [9] Slade A,Stanic S.The impact of RTOG 0614 and RTOG 0933 trials in routine clinical practice:The US Survey of Utilization of Memantine and IMRT planning for hippocampus sparing in patients receiving whole brain radiotherapy for brain metastases[J].Contemp Clin Trial,2016,47(5):74-77.DOI:10.1016/j.cct.2015.12.013
2018, Vol. 27 
