Cancer Res Treat.  2019 Apr;51(2):568-575. 10.4143/crt.2018.206.

Verification of Low Risk for Perihippocampal Recurrence in Patients with Brain Metastases Who Received Whole-Brain Radiotherapy with Hippocampal Avoidance

Affiliations
  • 1Department of Radiation Oncology, Kyung Hee University Hospital, Seoul, Korea.
  • 2Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. kimandre@catholic.ac.kr

Abstract

PURPOSE
The purpose of this study was to analyze the patterns of failure and survival outcome in patients with brain metastases who received whole-brain radiotherapy (WBRT) with hippocampal avoidance (HA) using simultaneous integrated boost (SIB) on metastatic brain tumors.
MATERIALS AND METHODS
We retrospectively reviewed 42 patients treated with HA-WBRT for brain metastases. A total of 25 Gy for whole brain and 35-55 Gy for gross tumors were delivered with 10 fractionations. Local tumor and intracranial progression were defined as a recurrence or tumor progression in SIB field and any recurrence or tumor progression within whole brain, respectively. Progression in HA zone was defined as the recurrence within the area expanded 5 mm from HA zone.
RESULTS
Median follow-up duration was 10.0 months (range, 4.1 to 56.4 months). Intracranial progression was observed in 13 patients (31.0%) and the median duration from the start of HA-WBRT to progression was 10.6 months (range, 0.9 to 33.0 months). Local tumor progression and new metastasis outside SIB field occurred in 10 patients (23.8%) and nine patients (21.4%), respectively. There was no isolated hippocampal metastasis, except only one patient (2.4%) with multiple metastases inside and outside HA zone simultaneously. Median survival time and intracranial progression-free survival rate at 1 year were 19.4 months (95% confidence interval [CI], 9.6 to 29.2) and 71.5%, respectively, and those for overall survival were 26.5 months (95% CI, 15.4 to 37.5) and 67.9%, respectively.
CONCLUSION
HA-WBRT was associated with low risk of new metastasis in HA region in the patients with brain metastases. These findings would serve as useful guidance on applying HA-WBRT in clinical practice.

Keyword

Brain; Neoplasm metastasis; Hippocampus; Radiotherapy; Recurrence

MeSH Terms

Brain Neoplasms
Brain*
Disease-Free Survival
Follow-Up Studies
Hippocampus
Humans
Neoplasm Metastasis*
Radiotherapy*
Recurrence*
Retrospective Studies

Figure

  • Fig. 1. Treatment plan of a 40-year-old woman who received whole brain radiotherapy with hippocampal avoidance for two brain metastases from non-small cell lung cancer. (A-C) Dose distribution of axial, coronal, and sagittal plane. (D) Dosevolume histogram for boosted metastatic tumors (red), whole brain (green), and both of hippocampus (blue).

  • Fig. 2. Patterns of failure in patients who received whole brain radiotherapy with hippocampal avoidance for brain metastases. SIB, simultaneous integrated boost; HA, hippocampus avoidance.

  • Fig. 3. Local tumor control (A), intracranial progression free survival (PFS) (B), and overall survival (C) in patients who received whole brain radiotherapy with hippocampal avoidance for brain metastases. CI, confidence interval.


Reference

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