Department of Radiation Oncology, Massachusetts General Hospital, 30 Fruit Street, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
J Neurooncol. 2020 May;148(1):81-88. doi: 10.1007/s11060-020-03491-y. Epub 2020 Apr 19.
Cranial irradiation results in cognitive decline, which is hypothesized to be partially attributable to hippocampal injury and stem cell loss. Recent advances allow for targeted reduction of radiation dose to the hippocampi while maintaining adequate dose coverage to the brain parenchyma and additional increasing dose to brain metastases, a approach called hippocampal avoidance whole brain radiation therapy with a simultaneous integrated boost (HA-WBRT + SIB.) We review our early clinical experience with HA-WBRT + SIB.
We evaluated treatments and clinical outcomes for patients treated with HA-WBRT + SIB between 2014 and 2018.
A total of 32 patients (median age, 63.5 years, range 45.3-78.8 years) completed HA-WBRT + SIB. Median follow-up for patients alive at the time of analysis was 11.3 months. The most common histology was non-small cell lung cancer (n = 22). Most patients (n = 25) were prescribed with WBRT dose of 30 Gy with SIB to 37.5 Gy in 15 fractions. Volumetric modulated arc therapy reduced treatment time (p < 0.0001). Median freedom from intracranial progression and overall survival from completion of treatment were 11.4 months and 19.6 months, respectively. Karnofsky Performance Status was associated with improved survival (p = 0.008). The most common toxicities were alopecia, fatigue, and nausea. Five patients developed cognitive impairment, including grade 1 (n = 3), grade 2 (n = 1), and grade 3 (n = 1).
HA-WBRT + SIB demonstrated durable intracranial disease control with modest side effects and merits further investigation as a means of WBRT toxicity reduction while improving long-term locoregional control in the brain.
颅部放疗可导致认知能力下降，据推测，这种下降部分归因于海马损伤和干细胞丢失。最近的进展允许有针对性地减少海马的放射剂量，同时保持对脑实质和其他脑转移灶的足够剂量覆盖，这一方法称为海马回避全脑放疗联合同步整合推量（HA-WBRT+SIB）。我们回顾了我们在 HA-WBRT+SIB 方面的早期临床经验。
我们评估了 2014 年至 2018 年间接受 HA-WBRT+SIB 治疗的患者的治疗方法和临床结果。
共有 32 名患者（中位年龄 63.5 岁，范围 45.3-78.8 岁）完成了 HA-WBRT+SIB。在分析时存活的患者中位随访时间为 11.3 个月。最常见的组织学类型是非小细胞肺癌（n=22）。大多数患者（n=25）接受了 30Gy 的 WBRT 剂量，SIB 剂量为 37.5Gy，共 15 次。容积调强弧形治疗降低了治疗时间（p<0.0001）。从治疗完成开始的无颅内进展和总生存中位数分别为 11.4 个月和 19.6 个月。卡氏功能状态与生存改善相关（p=0.008）。最常见的毒性反应是脱发、疲劳和恶心。5 名患者出现认知障碍，包括 1 级（n=3）、2 级（n=1）和 3 级（n=1）。
HA-WBRT+SIB 显示出持久的颅内疾病控制，副作用适度，值得进一步研究，作为减少 WBRT 毒性的方法，同时提高脑内局部区域控制的长期效果。
