Department of Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; University of Queensland, Brisbane, QLD, Australia.
University of Queensland, Brisbane, QLD, Australia.
J Clin Neurosci. 2014 Jan;21(1):86-90. doi: 10.1016/j.jocn.2013.04.005. Epub 2013 Oct 3.
The neurocognitive effects of cranial radiotherapy in patients with gliomas are well-recognised and may be related to the dose delivered to the hippocampi. Intensity modulated radiotherapy (IMRT) is a radiotherapy technique that can be used to selectively spare the hippocampi without compromising the dose delivered to the tumour. This study aimed to evaluate if hippocampal-sparing IMRT is achievable in patients with World Health Organization (WHO) grade II and III gliomas. A retrospective review of consecutive patients with WHO grade II and III gliomas treated with IMRT at our institution between January 2009 and August 2012 was performed. Hippocampal-sparing was defined as a mean dose to at least one hippocampus of less than 30 Gy. The dose delivered to the tumour was never compromised to achieve the hippocampal dose constraint. Logistic regression analyses were performed to identify predictive factors for achieving hippocampal-sparing treatment. Eighteen patients were identified and hippocampal-sparing was achieved in 14 (78%). The median dose prescribed was 59.4 Gy in 33 fractions and 11 patients had WHO grade III gliomas. The mean dose to the contralateral hippocampus was 24.9 Gy. Planning target volumes less than 420.5 cm3 were more likely to enable hippocampal-sparing treatment to be given (hazard ratio 1.7, p=0.03) and there was a trend with oligodendrogliomas and anaplastic oligodendrogliomas. Hippocampal-sparing radiotherapy is feasible in patients with WHO grade II and III gliomas. Oncologic outcomes are yet to be assessed prospectively. The relationship between hippocampal dose and neurocognitive function in adults is currently under investigation.
颅放疗对胶质瘤患者的神经认知影响是众所周知的，可能与海马体所接受的剂量有关。调强放疗（IMRT）是一种放疗技术，可选择性地保护海马体，而不影响肿瘤所接受的剂量。本研究旨在评估在 WHO 分级 II 和 III 级胶质瘤患者中是否可行海马体保护的调强放疗。对 2009 年 1 月至 2012 年 8 月在我院接受 IMRT 治疗的连续 WHO 分级 II 和 III 级胶质瘤患者进行回顾性研究。海马体保护定义为至少一侧海马体的平均剂量小于 30Gy。为了达到海马体剂量限制，肿瘤所接受的剂量决不会受到影响。进行逻辑回归分析以确定实现海马体保护治疗的预测因素。共确定了 18 例患者，其中 14 例（78%）实现了海马体保护。规定的中位剂量为 59.4Gy/33 次，11 例患者为 WHO 分级 III 级胶质瘤。对侧海马体的平均剂量为 24.9Gy。计划靶体积小于 420.5cm3 更有可能使海马体保护治疗成为可能（风险比 1.7，p=0.03），少突细胞瘤和间变性少突胶质细胞瘤也有这种趋势。在 WHO 分级 II 和 III 级胶质瘤患者中，海马体保护放疗是可行的。肿瘤学结果尚待前瞻性评估。海马体剂量与成人神经认知功能之间的关系目前正在研究中。
