Cook Theresa A, Hoffmann Matthew R, Ross Amie J, Turnbull Kirsty J, Westhuyzen Justin, Aherne Noel J
Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.
Department of Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, New South Wales, Australia.
Rep Pract Oncol Radiother. 2021 Dec 30;26(6):968-975. doi: 10.5603/RPOR.a2021.0119. eCollection 2021.
Hippocampal avoidance techniques are an evolving standard of care for patients undergoing cranial irradiation. Our aim was to assess the oncological outcomes and patterns of failure following hippocampal avoidance prophylactic cranial irradiation (HA-PCI) as a standard of care in unselected patients with both limited and extensive stage small cell lung carcinoma.
Consecutive patients with small cell lung carcinoma with a complete (limited stage) or good partial (extensive stage) response following chemotherapy were eligible to receive HA-PCI, with a total dose of 25 Gray in 10 fractions. All patients had a negative baseline MRI brain scan with gadolinium prior to HA-PCI. Patients had baseline and follow up Common Toxicity Criteria Adverse Event assessments. Following completion of HA-PCI, all patients had three-monthly MRI brain scans with gadolinium until confirmation of intracranial relapse, as well as three-monthly CT of the chest, abdomen and pelvis. Overall and progression-free survival were calculated using the Kaplan-Meier method.
A total of 17 consecutive patients, 9 men and 8 women, with a mean age of 70 years received HA-PCI between May 2016 and June 2020 after completion of their initial chemotherapy. There were no Grade 4 or greater adverse events. No patient had an isolated hippocampal avoidance zone relapse alone; three of 17 patients had multifocal relapses that included the hippocampal avoidance zone.
In our series, there were no hippocampal only relapses and we conclude that HA-PCI is a safe alternative to standard PCI in the setting of small cell lung cancer.
海马体避让技术是接受颅脑放疗患者不断发展的护理标准。我们的目的是评估海马体避让预防性颅脑放疗（HA-PCI）作为未选择的局限性和广泛期小细胞肺癌患者护理标准后的肿瘤学结局和失败模式。
化疗后达到完全缓解（局限性期）或良好部分缓解（广泛期）的小细胞肺癌连续患者有资格接受HA-PCI，总剂量为25格雷，分10次给予。所有患者在HA-PCI前进行了钆增强的基线脑部MRI扫描。患者进行了基线和随访的常见毒性标准不良事件评估。HA-PCI完成后，所有患者每三个月进行一次钆增强脑部MRI扫描，直至确认颅内复发，同时每三个月进行一次胸部、腹部和骨盆CT扫描。采用Kaplan-Meier方法计算总生存期和无进展生存期。
2016年5月至2020年6月期间，共有17例连续患者（9例男性和8例女性）在完成初始化疗后接受了HA-PCI，平均年龄为70岁。没有4级或更高级别的不良事件。没有患者仅出现孤立的海马体避让区复发；17例患者中有3例出现多灶性复发，包括海马体避让区。
在我们的系列研究中，没有仅海马体复发的情况，我们得出结论，在小细胞肺癌的情况下，HA-PCI是标准PCI的安全替代方案。
