Hippocampal sparing in stereotactic radiotherapy for brain metastases: To contour or not contour the hippocampus?

Carlo, C. Di; Trignani, Marianna; Caravatta, L.; Vinciguerra, A.; Augurio, Antonietta; Perrotti, Francesca; Tommaso, M. Di; Nuzzo, M.; Giancaterino, S.; Falco, M.D.; Genovesi, Domenico

doi:10.1016/j.canrad.2017.08.113

Cited by 5 publications

(2 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, Di Carlo et al, performed a retrospective analysis of hippocampal doses with and without hippocampal-sparing in patient treated with fractionated stereotactic radiotherapy [19] . They found that hippocampal constraints, specifically D max and D 40 , were exceeded in almost half of the cases without hippocampal-sparing, including all those with multiple brain metastases.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery optimization with hippocampal-sparing in patients treated for brain metastases

Burgess

Nair

Gratton

et al. 2021

Physics and Imaging in Radiation Oncology

View full text Add to dashboard Cite

Background and purpose: Cranial irradiation is associated with significant neurocognitive sequelae, secondary to radiation-induced damage to hippocampal cells. It has been shown that hippocampal-sparing (HS) leads to modest benefit in neurocognitive function in patients with brain metastases, but further improvement is possible. We hypothesized that improved benefits could be seen using HS in patients treated with stereotactic radiation (HS-SRS). Our study evaluated whether the hippocampal dose could be significantly reduced in the treatment of brain metastases using SRS, while maintaining target coverage. Materials and methods: Sixty SRS plans were re-planned to minimize dose to the hippocampus while maintaining target coverage. Patients with metastases within 5 mm of the hippocampus were excluded. Minimum, mean, maximum and dose to 40% (mean equivalent dose in 2 Gy per fraction, EQD 2 to the hippocampus) were compared between SRS and HS-SRS plans. Median number of brain metastases was two. Results: Compared to baseline SRS plans, hippocampal-sparing plans demonstrated D min was reduced by 35%, from 0.4 Gy to 0.3 Gy (p-value 0.02). Similarly, D max was reduced by 55%, from 8.2 Gy to 3.6 Gy, D mean by 52%, from 1.6 Gy to 0.5 Gy, and D 40 by 50%, from 1.8 Gy to 0.9 Gy (p-values <0.001). Conclusions: Our study demonstrated that further reduction of hippocampal doses of more than 50% is possible in the treatment of brain metastases with SRS using dose optimization. This could result in significantly improved neurocognitive outcomes for patients treated for brain metastases.

show abstract

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery optimization with hippocampal-sparing in patients treated for brain metastases

Burgess

Nair

Gratton

et al. 2021

Physics and Imaging in Radiation Oncology

View full text Add to dashboard Cite

show abstract

“…The proposed doses refer to conventional radiotherapy in which the fractional dose oscillates between 2 and 3 Gy. The problem arises in the case of hypofractionated RT and in particular stereotactic RT, although there are newer reports of "protective" doses in the hippocampus region in such cases [59,60].…”

Section: Clinical Situations In Which Hippocampal Protection Should Bmentioning

confidence: 99%

Benefits and difficulties during brain radiotherapy planning with hippocampus sparing

2019

View full text Add to dashboard Cite

Radiotherapy (RT) is frequently used in the treatment of primary and secondary brain tumours, as well as in prophylactic cranial irradiation (PCI). The hippocampus plays a key function in the process of remembering, relaying information from short-term to long-term memory as consolidation, and spatial orientation. Sparing the hippocampus during brain radiotherapy aims to prevent hippocampal-dependent cognitive function deterioration.This procedure requires a good knowledge of the brain's radiological anatomy and use of modern radiotherapy techniques.This article presents the validity of hippocampus sparing during brain radiotherapy, the potential benefits of using this procedure, available clinical premises regarding patient qualification, and technical difficulties in the brain's RT planning with hippocampus avoidance.

show abstract

Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education

Sorce

Chalaszczyk

Rossi

et al. 2021

Critical Reviews in Oncology/Hematology

View full text Add to dashboard Cite

Hippocampal sparing in stereotactic radiotherapy for brain metastases: To contour or not contour the hippocampus?

Cited by 5 publications

References 31 publications

Stereotactic radiosurgery optimization with hippocampal-sparing in patients treated for brain metastases

Stereotactic radiosurgery optimization with hippocampal-sparing in patients treated for brain metastases

Benefits and difficulties during brain radiotherapy planning with hippocampus sparing

Recommendation for the contouring of limbic system in patients receiving radiation treatment: A pictorial review for the everyday practice and education

Contact Info

Product

Resources

About