scholarly journals Hippocampal Avoidance in Multitarget Radiosurgery

Cureus ◽  
2021 ◽  
Author(s):  
Zachary Gude ◽  
Justus Adamson ◽  
John P Kirkpatrick ◽  
William Giles
Keyword(s):  
Hippocampal Avoidance

scholarly journals Management of multiple brain metastases: a patterns of care survey within the German Society for Radiation Oncology

2021 ◽  
Author(s):  
Johannes Kraft ◽  
Michael Mayinger ◽  
Jonas Willmann ◽  
Michelle Brown ◽  
Stephanie Tanadini-Lang ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Radiation Oncology ◽  
Online Survey ◽  
Whole Brain Radiotherapy ◽  
German Society ◽  
Patterns Of Care ◽  
Prognostic Scores ◽  
Mutational Status ◽  
Hippocampal Avoidance ◽  
Current Guidelines

Abstract Purpose The treatment of brain metastases (BM) has changed considerably in recent years and in particular, the management of multiple BM is currently undergoing a paradigm shift and treatment may differ from current guidelines. This survey was designed to analyze the patterns of care in the management of multiple BM. Methods An online survey consisting of 36 questions was distributed to the members of the German Society for Radiation Oncology (DEGRO). Results In total, 193 physicians out of 111 institutions within the German Society for Radiation oncology responded to the survey. Prognostic scores for decision making were not used regularly. Whole brain radiotherapy approaches (WBRT) are the preferred treatment option for patients with multiple BM, although stereotactic radiotherapy treatments are chosen by one third depending on prognostic scores and overall number of BM. Routine hippocampal avoidance (HA) in WBRT is only used by a minority. In multiple BM of driver-mutated non-small cell lung cancer origin up to 30% favor sole TKI therapy as upfront treatment and would defer upfront radiotherapy. Conclusion In multiple BM WBRT without hippocampal avoidance is still the preferred treatment modality of choice regardless of GPA and mutational status, while SRT is only used in patients with good prognosis. Evidence for both, SRS and hippocampal avoidance radiotherapy, is growing albeit the debate over the appropriate treatment in multiple BM is yet not fully clarified. Further prospective assessment of BM management—ideally as randomized trials—is required to align evolving concepts with the proper evidence and to update current guidelines.

Hippocampal Avoidance Prophylactic Cranial Irradiation for SCLC

2021 ◽  
Vol 16 (6) ◽  
pp. e41-e42 ◽  
Author(s):  
William G. Breen ◽  
Paul D. Brown ◽  
Nadia N. Laack
Keyword(s):  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Hippocampal Avoidance

Randomized Phase III Trial of Prophylactic Cranial Irradiation With or Without Hippocampal Avoidance for Small-Cell Lung Cancer (PREMER): A GICOR-GOECP-SEOR Study

2021 ◽  
pp. JCO.21.00639
Author(s):  
Núria Rodríguez de Dios ◽  
Felipe Couñago ◽  
Mauricio Murcia-Mejía ◽  
Mikel Rico-Oses ◽  
Patricia Calvo-Crespo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Free Recall ◽  
Brain Metastases ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Small Cell ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Phase Iii Trial ◽  
Hippocampal Avoidance

PURPOSE Radiation dose received by the neural stem cells of the hippocampus during whole-brain radiotherapy has been associated with neurocognitive decline. The key concern using hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) in patients with small-cell lung cancer (SCLC) is the incidence of brain metastasis within the hippocampal avoidance zone. METHODS This phase III trial enrolled 150 patients with SCLC (71.3% with limited disease) to standard prophylactic cranial irradiation (PCI; 25 Gy in 10 fractions) or HA-PCI. The primary objective was the delayed free recall (DFR) on the Free and Cued Selective Reminding Test (FCSRT) at 3 months; a decrease of 3 points or greater from baseline was considered a decline. Secondary end points included other FCSRT scores, quality of life (QoL), evaluation of the incidence and location of brain metastases, and overall survival (OS). Data were recorded at baseline, and 3, 6, 12, and 24 months after PCI. RESULTS Participants' baseline characteristics were well balanced between the two groups. The median follow-up time for living patients was 40.4 months. Decline on DFR from baseline to 3 months was lower in the HA-PCI arm (5.8%) compared with the PCI arm (23.5%; odds ratio, 5; 95% CI, 1.57 to 15.86; P = .003). Analysis of all FCSRT scores showed a decline on the total recall (TR; 8.7% v 20.6%) at 3 months; DFR (11.1% v 33.3%), TR (20.3% v 38.9%), and total free recall (14.8% v 31.5%) at 6 months, and TR (14.2% v 47.6%) at 24 months. The incidence of brain metastases, OS, and QoL were not significantly different. CONCLUSION Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC. No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.

Simultaneously Integrated Boost to Multiple Brain Metastases during Whole Brain Radiation Therapy-Hippocampal Avoidance

Radiosurgery ◽  
2010 ◽  
pp. 247-257 ◽  
Author(s):  
Alonso N. Gutiérrez ◽  
Wolfgang A. Tomé ◽  
Amol Ghia ◽  
Sayana Thomas ◽  
George Cannon ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Multiple Brain Metastases ◽  
Whole Brain Radiation ◽  
Hippocampal Avoidance ◽  
Integrated Boost ◽  
Brain Radiation
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