Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy |
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Authors: | Saskia Harth Yasser Abo-Madyan Lei Zheng Kerstin Siebenlist Carsten Herskind Frederik Wenz Frank A. Giordano |
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Affiliation: | 1. Department of Radiation Oncology;2. Experimental Radiation Oncology, Department of Radiation Oncology, Universitätsmedizin Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Germany;3. Department of Clinical Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Egypt |
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Abstract: | PurposeTo estimate the risk of undertreatment in hippocampal-sparing whole brain radiotherapy (HS-WBRT).MethodsEight hundred and fifty six metastases were contoured together with the hippocampi in cranial MRIs of 100 patients. For each metastasis, the distance to the closest hippocampus was calculated. Treatment plans for 10 patients were calculated and linear dose profiles were established. For SCLC and NSCLC, dose–response curves were created based on data from studies on prophylactic cranial irradiation, allowing estimating the risk for intracranial failure.ResultsOnly 0.4% of metastases were located inside a hippocampus in 3% of all patients. SCLC showed a relatively high rate of hippocampal metastasis (18.2% of all SCLC patients) and HS-WBRT in a commonly applied fractionation scheme would increase the risk for brain relapse by ∼4% compared to conventional WBRT. NSCLC showed a lower rate of brain metastasis in the hippocampi (2.8%) and HS-WBRT would account for a slightly increased absolute risk of 0.2%.ConclusionsProphylactic or therapeutic HS-WBRT is expected to be associated with a low risk of undertreatment. For SCLC, it bears a minimally elevated risk of failure compared to standard WBRT. In NSCLC, HS-WBRT is most likely not associated with a clinically relevant increase in risk of failure. |
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Keywords: | Brain metastasis Hippocampal-sparing whole brain radiotherapy Whole brain radiotherapy Prophylactic cranial irradiation |
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