Popp Ilinca, Rau Alexander, Kellner Elias, Reisert Marco, Fennell Jamina Tara, Rothe Thomas, Nieder Carsten, Urbach Horst, Egger Karl, Grosu Anca Ligia, Kaller Christoph P
Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Front Oncol. 2021 Aug 19;11:714709. doi: 10.3389/fonc.2021.714709. eCollection 2021.
With improved life expectancy, preventing neurocognitive decline after cerebral radiotherapy is gaining more importance. Hippocampal damage has been considered the main culprit for cognitive deficits following conventional whole-brain radiation therapy (WBRT). Here, we aimed to determine to which extent hippocampus-avoidance WBRT (HA-WBRT) can prevent hippocampal atrophy compared to conventional WBRT.
Thirty-five HA-WBRT and 48 WBRT patients were retrospectively selected, comprising a total of 544 contrast-enhanced T1-weighted magnetic resonance imaging studies, longitudinally acquired within 24 months before and 48 months after radiotherapy. HA-WBRT patients were treated analogously to the ongoing HIPPORAD-trial (DRKS00004598) protocol with 30 Gy in 12 fractions and dose to 98% of the hippocampus ≤ 9 Gy and to 2% ≤ 17 Gy. WBRT was mainly performed with 35 Gy in 14 fractions or 30 Gy in 10 fractions. Anatomical images were segmented and the hippocampal volume was quantified using the Computational Anatomy Toolbox (CAT), including neuroradiological expert review of the segmentations.
After statistically controlling for confounding variables such as age, gender, and total intracranial volume, hippocampal atrophy was found after both WBRT and HA-WBRT ( < 10). However, hippocampal decline across time following HA-WBRT was approximately three times lower than following conventional WBRT ( < 10), with an average atrophy of 3.1% 8.5% in the first 2 years after radiation therapy, respectively.
HA-WBRT is a therapeutic option for patients with multiple brain metastases, which can effectively and durably minimize hippocampal atrophy compared to conventional WBRT.
随着预期寿命的提高，预防脑放疗后的神经认知功能衰退变得越发重要。海马体损伤被认为是传统全脑放疗（WBRT）后认知缺陷的主要原因。在此，我们旨在确定与传统WBRT相比，海马体回避全脑放疗（HA-WBRT）在多大程度上能够预防海马体萎缩。
回顾性选取35例HA-WBRT患者和48例WBRT患者，共纳入544项对比增强T1加权磁共振成像研究，这些研究在放疗前24个月内及放疗后48个月内纵向获取。HA-WBRT患者按照正在进行的HIPPORAD试验（DRKS00004598）方案进行治疗，给予12次分割共30 Gy的剂量，海马体98%的剂量≤9 Gy，2%的剂量≤17 Gy。WBRT主要采用14次分割共35 Gy或10次分割共30 Gy的方案。对解剖图像进行分割，并使用计算解剖学工具箱（CAT）对海马体体积进行量化，包括神经放射学专家对分割结果的审查。
在对年龄、性别和总颅内体积等混杂变量进行统计学控制后，发现WBRT和HA-WBRT后均出现海马体萎缩（<0.01）。然而，HA-WBRT后海马体随时间的衰退比传统WBRT低约三倍（<0.01），放疗后前2年的平均萎缩率分别为3.1%和8.5%。
HA-WBRT是多脑转移瘤患者的一种治疗选择，与传统WBRT相比，它能有效且持久地将海马体萎缩降至最低。
