Radiation therapy in the prevention and management of brain metastases in patients with small cell lung cancer: a narrative review

Hau, Eric; Lim, Rebecca; Vinod, Shalini; Nahar, Nurun; Gee, Harriet E.; Pinkham, Mark B

doi:10.21037/cco-21-108

Cited by 2 publications

(6 citation statements)

References 82 publications

(101 reference statements)

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“…[1] Prospective phase II and randomized phase III SCLC trials have all confirmed the efficacy of HA-WBRT in preserving neurocognitive function, [2,3] though a different randomized trial found no decline in cognition in SCLC patients receiving HA-PCI compared to conventional PCI. [4] The use of the HA-WBRT technique may be recommended as the standard of care for limited-stage or countable brain metastatic lesions without metastasis around the HA region and good performance status in SCLC patients [5,8] The newly revised guidelines for limited-stage SCLC, HA-WBRT is recommended as a new strategy of radiation therapy for preserving cognition and memory. [5] Reducing the dose delivered to the HA region below the therapeutic level may increase the risk of hippocampal progression; thus, HA-WBRT may be associated with a risk of hippocampal recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…As we know, SCLC patients can have a higher incidence of brain metastases of more than 50% depending on the stage of the disease, so it is assumed that the entire brain is seeded with micrometastatic disease, even if no intracranial lesions are detected in imaging studies. [8] Furthermore, Korkmaz Kirakli and Oztekin [11] examined the cranial MRI of 54 SCLC patients and discovered that the hippocampal metastasis estimated rate was 32% (17 patients), with a total of 4.4% of all metastases involved the HA area. However, in the real world, a randomized phase III GICOR-GOECP-SEOR study reported that only-one SCLC patient developed isolated brain failure in the hippocampal region after HA-PCI during a median follow-up time of 40.4 months, [3] and another randomized phase III trial found no patient developing a metastasis within the hippocampus or underdosed region during a median follow-up of 26.6 months.…”

Section: Discussionmentioning

confidence: 99%

“…Recent clinical research recommends that hippocampus sparing could be a viable and dependable technique for reducing adverse cognitive effects in WBRT. [1][2][3][7][8][9][10][11] Perihippocampal failure is a rare clinical complication in patients with SCLC after HA-WBRT. The risk of perihippocampal failure following HA-WBRT is unknown in SCLC patients, but it may be theoretically higher than the counterpart of nonsmall-cell lung cancer.…”

Section: The Authors Have No Conflicts Of Interest To Disclosementioning

confidence: 99%

“…The risk of perihippocampal failure following HA-WBRT is unknown in SCLC patients, but it may be theoretically higher than the counterpart of nonsmall-cell lung cancer. [8,[11][12][13] Its clinical features have yet to be fully elucidated due to a lack of clinical data; thus, clinical cases must be observed. Herein, we present 3 cases of developing perihippocampus failure following HA-WBRT in SCLC patients and evaluate the relationship between the underdose of therapeutic cranial radiation and brain failure in the HA region.…”

Section: The Authors Have No Conflicts Of Interest To Disclosementioning

confidence: 99%

“…Recent clinical research recommends that hippocampus sparing could be a viable and dependable technique for reducing adverse cognitive effects in WBRT. [1–3,7–11]…”

Section: Introductionmentioning

confidence: 99%

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Perihippocampal failure after hippocampal-avoidance brain radiotherapy in small cell lung cancer patients: Cases report and literature review

Ho,

Shieh,

Lin

et al. 2024

Medicine

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Rationale: Brain metastasis is a major concern, and may occur in roughly 50% of patients during the clinical course of small cell lung cancer (SCLC). Because prophylactic cranial irradiation reduces the incidence of brain metastases and improves overall survival, prophylactic cranial irradiation is recommended for SCLC patients without distant metastases or an extensive stage and have responded well to systemic therapy. Hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) is preferred to preserve hippocampal function while minimizing negative cognitive effects. Patient concerns: Reducing the dose delivered to the hippocampus below the therapeutic brain dose may increase the risk of hippocampal progression; thus, HA-WBRT may be associated with a risk of perihippocampal recurrence. Diagnosis: Three patients with SCLC received HA-WBRT and developed intracranial failure during clinical follow-up; 3 relapsed with intracranial failure in the perihippocampal region after 12, 13, and 7 months, respectively. Intervention and outcomes: Compared to the therapeutic brain dose of cases and the underdose region around the HA region, we matched MRI scans of intracranial failure and previous planning scans of simulation and found a deviation of the underdosed region within the perihippocampal failure of approximately 55% to 63%. Lessons: Perihippocampal failure is a rare clinical outcome in SCLC patients following HA-WBRT. Perihippocampal failure could be caused by an underdose of radiation or by the aggressiveness of the cancer itself. More research into this topic is encouraged.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Authors Have No Conflicts Of Interest To Disclosementioning

confidence: 99%

Section: The Authors Have No Conflicts Of Interest To Disclosementioning

confidence: 99%

“…Recent clinical research recommends that hippocampus sparing could be a viable and dependable technique for reducing adverse cognitive effects in WBRT. [1–3,7–11]…”

Section: Introductionmentioning

confidence: 99%

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