ArticleBMC cancer2020
Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study.
Article in BMC cancer, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Diagnosis and management of brain metastasis from thyroid cancer.Endocrine oncology (Bristol, England) · 2025Review
- High Radiation Dose to the Fornix Causes Symptomatic Radiation Necrosis in Patients with Anaplastic Oligodendroglioma.Yonsei medical journal · 2024Article
- Unilateral hippocampal sparing during whole brain radiotherapy for multiple brain metastases: narrative and critical review.Frontiers in oncology · 2024Review
- Mitigating Radiotoxicity in the Central Nervous System: Role of Proton Therapy.Current treatment options in oncology · 2023Review
- Neurocognition and mean radiotherapy dose to vulnerable brain structures: new organs at risk?Radiation oncology (London, England) · 2023Article
- Frequency of metastases within the hypothalamic-pituitary area and the associated high-risk factors in patients with brain metastases.Frontiers in neurology · 2023Article
- Review
- The Learning Curve and Inter-Observer Variability in Contouring the Hippocampus under the Hippocampal Sparing Guidelines of Radiation Therapy Oncology Group 0933.Current oncology (Toronto, Ont.) · 2022Article
- High prevalence of anterior pituitary deficiencies after cranial radiation therapy for skull base meningiomas.BMC cancer · 2021Article
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9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundFeasibility testing of a simultaneous sparing approach of hippocampus, hypothalamus and pituitary gland in patients undergoing whole-brain radiotherapy (WBRT) with and without a concomitant boost to metastatic sites.
introductionCognitive impairment and hormonal dysfunction are common side effects of cranial radiotherapy. A reduced dose application to the patho-physiologically involved functional brain areas, i.e. hippocampus, hypothalamus and pituitary gland, could reduce these common side effects. While hippocampal sparing is already a common practice to improve cognitive outcome, technical experience of additional combined sparing of the hypothalamus/pituitary gland (HT-P) is insufficient.
methodsTwenty patients were included in the planning study. In 11 patients, a total dose of 36 Gy of WBRT (2 Gy per fraction) plus a simultaneous integrated boost (SIB) of 9 Gy (0.5 Gy per fraction, total dose: 45 Gy) to the brain metastases was applied. In 9 patients, prophylactic cranial irradiation (PCI) was simulated with a total dose of 30 Gy (2 Gy per fraction). In both patient cohorts, a sparing approach of the hippocampus and the HT-P area was simulated during WBRT. For all treatment plans, volumetric modulated arc therapy (VMAT) was used. Quality assurance included assessment of homogeneity, conformality and target coverage.
resultsThe mean dose to the hippocampus and HT-P region was limited to less than 50% of the prescribed dose to the planning target volume (PTV) in all treatment plans. Dose homogeneity (HI) of the target volume was satisfying (median HI = 0.16 for WBRT+SIB and 0.1 for PCI) and target coverage (conformation number, CN) was not compromised (median CN = 0.82 for SIB and 0.86 for PCI).
conclusionSimultaneous dose reduction to the hippocampus and the HT-P area did not compromise the PTV coverage in patients undergoing WBRT+SIB or PCI using VMAT. While the feasibility of the presented approach is promising, prospective neurologic, endocrine outcome and safety studies are required.
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