Integral dose delivered to normal brain with conventional intensity‐modulated radiotherapy (<scp>IMRT</scp>) and helical tomotherapy <scp>IMRT</scp> during partial brain radiotherapy for high‐grade gliomas with and without selective sparing of the hippocampus, limbic circuit and neural stem cell compartment

Marsh, J. W.; Ziel, G Ellis; Diaz, Aidnag; Wendt, Julie; Gobole, Rohit; Turian, J

doi:10.1111/1754-9485.12048

Cited by 21 publications

(14 citation statements)

References 35 publications

(55 reference statements)

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“…Our dosimetric results for VMAT planning also showed a trend toward dose reduction when compared to 3D-CRT in contralateral OAR and the infratentorial brain. However, for future multiplearc treatments, non-coplanar VMAT [43,44] might be an excellent study objective to provide further improvements in OAR sparing in HGG.…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

et al. 2016

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“…In an effort to minimize dose in hippocampus, there is a risk of overtreatment of other parts of the brain and surrounding structures with increased risk of induced secondary malignancies. To assess this potential disadvantage of helical tomotherapy, one study measured integral doses in uninvolved brain regions of HGG patients for both conventional IMRT and helical tomotherapy techniques [57]. The results proved reduction of brain integral dose in average by 23% after IMRT compared with tomotherapy in all tested treatment plans.…”

Section: Introductionmentioning

confidence: 99%

Why and how to spare the hippocampus during brain radiotherapy: the developing role of hippocampal avoidance in cranial radiotherapy

et al. 2014

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The goal of this review is to summarize the rationale for and feasibility of hippocampal sparing techniques during brain irradiation. Radiotherapy is the most effective non-surgical treatment of brain tumors and with the improvement in overall survival for these patients over the last few decades, there is an effort to minimize potential adverse effects leading to possible worsening in quality of life, especially worsening of neurocognitive function. The hippocampus and associated limbic system have long been known to be important in memory formation and pre-clinical models show loss of hippocampal stem cells with radiation as well as changes in architecture and function of mature neurons. Cognitive outcomes in clinical studies are beginning to provide evidence of cognitive effects associated with hippocampal dose and the cognitive benefits of hippocampal sparing. Numerous feasibility planning studies support the feasibility of using modern radiotherapy systems for hippocampal sparing during brain irradiation. Although results of the ongoing phase II and phase III studies are needed to confirm the benefit of hippocampal sparing brain radiotherapy on neurocognitive function, it is now technically and dosimetrically feasible to create hippocampal sparing treatment plans with appropriate irradiation of target volumes. The purpose of this review is to provide a brief overview of studies that provide a rationale for hippocampal avoidance and provide summary of published feasibility studies in order to help clinicians prepare for clinical usage of these complex and challenging techniques.

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“…[9] Also, not little evidence supports that impaired hippocampal neurogenesis caused by radiation-induced damage [10][11][12][13] should be strongly associated with NCF impairment. [9,14] Furthermore, several studies showed that isodose distribution in the hippocampus is closely related to NCFs in patients with primary brain tumors [15][16][17] or in those with nasopharyngeal carcinoma. [14] Consequently, it is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might lead to significant preservation in terms of cognitive function.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Evaluating the impact of hippocampal sparing during whole brain radiotherapy on neurocognitive functions: A preliminary report of a prospective phase II study

Lin¹,

Yang²,

Wu³

et al. 2015

Biomed J

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Background: Whole brain radiotherapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCFs) decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving WBRT. Methods:Twenty-five patients who were referred for prophylactic cranial irradiation (PCI) or treating oligometastatic brain disease were enrolled in the study. Before the HA-WBRT course, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed. The primary endpoint was delayed recall, as determined by the change/decline in verbal memory [Wechsler Memory Scale -3 rd edition (WMS III)-Word List score] from the baseline assessment to 4 months after the start of HA-WBRT. Results:Only three patients belonged to the clinical setting of PCI; the remaining 22 patients had oligometastatic brain disease. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiotherapy intervals, in immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F = 5.727, p = 0.048). Conclusions: Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA-WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control. (Biomed J 2015;38:439-449) Key words: brain metastasis, hippocampus, hippocampus avoidance during whole brain radiotherapy, neurocognitive function, whole brain radiotherapy

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Integral dose delivered to normal brain with conventional intensity‐modulated radiotherapy (IMRT) and helical tomotherapy IMRT during partial brain radiotherapy for high‐grade gliomas with and without selective sparing of the hippocampus, limbic circuit and neural stem cell compartment

Abstract: In the setting of PBRT for high-grade gliomas, IMRT reduces IDbrain compared with HT with or without selective SPA of contralateral hippocampus, limbic circuit and NSC, and the use of selective SPA reduces IDbrain compared with STD PBRT delivered with either traditional IMRT or HT.

Cited by 21 publications

References 35 publications

Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma

Why and how to spare the hippocampus during brain radiotherapy: the developing role of hippocampal avoidance in cranial radiotherapy

Evaluating the impact of hippocampal sparing during whole brain radiotherapy on neurocognitive functions: A preliminary report of a prospective phase II study

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