Department of Radiation Oncology,307 Clinical College,Anhui Medical University,Beijing 100071,China (Che DM,Wu SHK);Department of Radiation Oncology,307 Hospital of PLA,Beijing 100071,China (Che DM,Meng XY,Shen G,Sun B,Cong Y,Liu CH,Wang Q,Wang JL,Hao RM,Wu SK)
AbstractObjective To investigate the incidence of and high-risk factors for hippocampal metastasis (HM) in patients with brain metastases of lung cancer, to determine the safety of hippocampus-sparing whole brain radiotherapy (HS-WBRT), and to find out patients eligible for HS-WBRT. Methods A retrospective study was performed on clinical data from 345 patients with brain metastases of lung cancer who were admitted to our hospital from 2011 to 2014. The hippocampus plus a 5-mm margin was delineated. Univariate and multivariate logistic analyses were used to identify high-risk factors for hippocampal metastasis. The Cox model was used for multivariate prognostic analysis. Results In the 345 patients, there were 1621 intracranial metastatic lesions. Sixteen (4.6%) of the 345 patients and 16(0.99%) of the 1621 intracranial metastatic lesions had hippocampal metastasis;42(12.2%) of the 345 patients and 45(2.78%) of the 1621 intracranial metastatic lesions had metastasis in the hippocampus plus a 5-mm margin. The univariate and multivariate logistic analyses showed that the number of brain metastases was correlated with hippocampal metastasis (HR=1.14,P=0.000). In the 139 patients with intracranial progression after treatment, 17(12.2%) had hippocampal metastasis recurrence. The Cox prognostic analysis showed that tumor stage and genetic information were related to the overall survival in patients with brain metastases. Conclusions The number of brain metastases is a high-risk factor for hippocampal metastasis. The lung cancer patients with more brain metastases have a higher incidence of hippocampal metastasis. HS-WBRT is recommended for lung cancer patients with fewer brain metastases, early-stage disease, and genetic mutations or rearrangement.
Chen Dongmei,Meng Xiangying,Shen Ge et al. Incidence and the high-risk factors of intracranial metastases in the perhippocampus regoin in 345 patients with lung cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(2): 138-143.
Chen Dongmei,Meng Xiangying,Shen Ge et al. Incidence and the high-risk factors of intracranial metastases in the perhippocampus regoin in 345 patients with lung cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(2): 138-143.
[1] Le Péchoux C,Sun A,Slotman BJ,et al. Prophylactic cranial irradiation for patients with lung cancer[J].Lancet Oncol,2016,17(7):e277-e293.DOI:10.1016/s1470-2045(16)30065-1. [2] Sehlen S,Lenk M,Hollenhorst H,et al. Quality of life (QoL) as predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy[J].Onkologie,2003,26(1):38-43.DOI:10.1159/000069862. [3] 杨海燕,孙冰,王军良,等.WBRT中保护海马的调强计划设计[J].中国医学物理学杂志,2016,33(3):322-324.DOI:10.3969/j.issn.1005-202X.2016.03.022. Yang HY,Sun B,Wang JL,et al. Whole brain intensity modulated radiotherapy with hippocampus protection[J].Chin J Med Phys,2016,33(3):322-324.DOI:10.3969/j.issn.1005-202X.2016.03.022. [4] 董昕,周宗玫.海马回保护在WBRT中的临床应用意义[J].中华放射肿瘤学杂志,2016,25(5):526-529.DOI:10.3760/cma.j.issn.1004-4221.2016.05.023. Dong X,Zhou ZM.Clinical value of hippocampal gyrus protection in whole brain radiotherapy[J].Chin J Radiat Oncol,2016,25(5):526-529.DOI:10.3760/cma.j.issn.1004-4221.2016.05.023. [5] Chason JL,Walker FB,Landers JW.Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study[J].Cancer,1963,16(6):781-787.DOI:10.1002/1097-0142(196306)16:6<781::AID-CNCR2820160614>3.0.CO;2-M. [6] Rava P,Leonard K,Sioshansi S,et al. Survival among patients with 10 or more brain metastases treated with stereotactic radiosurgery[J].J Neurosurg,2013,119(2):457-462.DOI:10.3171/2013.4.jns121751. [7] Brastianos HC,Cahill DP,Brastianos PK.Systemic therapy of brain metastases[J].Curr Neurol Neurosci Rep,2015,15(2):518.DOI:10.1007/s11910-014-0518-9. [8] Cross NE,Glantz MJ.Neurologic complications of radiation therapy[J].Neurol Clin,2003,21(1):249-277.DOI:10.1016/S0733-8619(02)00031-2. [9] DeAngelis LM,Delattre JY,Posner JB.Radiation-induced dementia in patients cured of brain metastases[J].Neurology,1989,39(6):789.DOI:10.1212/WNL.39.6.789. [10] Tsai PF,Yang CC,Chuang CC,et al. Hippocampal dosimetry correlates with the change in neurocognitive function after hippocampal sparing during whole brain radiotherapy:a prospective study[J].Radiat Oncol,2015,10(1):253.DOI:10.1186/s13014-015-0562-x. [11] Marsh JC,Herskovic AM,Gielda BT,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. [12] 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. [13] 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(1):62.DOI:10.1186/1748-717X-8-62. [14] 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 Radiat Res,2013,54(2):285-291.DOI:10.1093/jrr/rrs085. [15] Harth S,Abo-Madyan Y,Zheng L,et al. Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy[J].Radiother Oncol,2013,109(1):152-158.DOI:10.1016/j.radonc.2013.09.009. [16] Wu SG,Rao MY,Zhou J,et al. Distribution of metastatic disease in the brain in relation to the hippocampus:a retrospective single-center analysis of 6064 metastases in 632 patients[J].Oncotarget,2015,6(41):44030-44036.DOI:10.18632/oncotarget.5828. [17] Gondi V,Tomé WA,Marsh J,et al. Estimated risk of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy:safety profile for RTOG 0933[J].Radiother Oncol,2010,95(3):327-331.DOI:10.1016/j.radonc.2010.02.030. [18] Sun B,Huang Z,Wu SK,et al. Incidence and relapse risk of intracranial metastases within the perihippocampal region in 314 patients with breast cancer[J].Radiother Oncol,2016,118(1):181-186.DOI:10.1016/j.radonc.2015.11.010. [19] Gondi V,Tolakanahalli R,Mehta MP,et al. Hippocampal-sparing whole-brain radiotherapy:a"how-to" technique using helical tomotherapy and linear accelerator-based intensity-modulated radiotherapy[J].Int J Radiat Oncol Biol Phys,2010,78(4):1244-1252.DOI:10.1016/j.ijrobp.2010.01.039. [20] Oehlke O,Wucherpfennig D,Fels F,et al. Whole brain irradiation with hippocampal sparing and dose escalation on multiple brain metastases[J].Strahlentherapie und Onkologie,2015,191(6):461-469.DOI:10.1007/s00066-014-0808-9. [21] Nayak L,Lee EQ,Wen PY.Epidemiology of brain metastases[J].Curr Oncol Rep,2012,14(1):48-54.DOI:10.1007/s11912-011-0203-y. [22] Lin NU,Amiri-Kordestani L,Palmieri D,et al. CNS metastases in breast cancer:old challenge,new frontiers[J].Clin Cancer Res,2013,19(23):6404-6418.DOI:10.1158/1078-0432.CCR-13-0790. [23] Videtic GMM,Reddy CA,Chao ST,et al. Gender,race,and survival:a study in non-small-cell lung cancer brain metastases patients utilizing the radiation therapy oncology group recursive partitioning analysis classification[J].Int J Radiat Oncol Biol Phys,2009,75(4):1141-1147.DOI:10.1016/j.ijrobp.2008.12.022. [24] Oh Y,Taylor S,Bekele BN,et al. Number of metastatic sites is a strong predictor of survival in patients with nonsmall cell lung cancer with or without brain metastases[J].Cancer,2009,115(13):2930-2938.DOI:10.1002/cncr.24333. [25] Willett A,Wilkinson JB,Shah C,et al. Management of solitary and multiple brain metastases from breast cancer[J].Indian J Med Paediatr Oncol,2015,36(2):87-93.DOI:10.4103/0971-5851.158835. [26] Johung KL,Yao XP,Li FY,et al. A clinical model for identifying radiosensitive tumor genotypes in non-small cell lung cancer[J].Clin Cancer Res,2013,19(19):5523-5532.DOI:10.1158/1078-0432.CCR-13-0836.
2017, Vol. 26 
