Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume
Background and PurposeWith 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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.714709/full |
| _version_ | 1818577204488962048 |
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| author | Ilinca Popp Alexander Rau Elias Kellner Marco Reisert Jamina Tara Fennell Thomas Rothe Carsten Nieder Carsten Nieder Horst Urbach Karl Egger Anca Ligia Grosu Anca Ligia Grosu Christoph P. Kaller |
| author_facet | Ilinca Popp Alexander Rau Elias Kellner Marco Reisert Jamina Tara Fennell Thomas Rothe Carsten Nieder Carsten Nieder Horst Urbach Karl Egger Anca Ligia Grosu Anca Ligia Grosu Christoph P. Kaller |
| author_sort | Ilinca Popp |
| collection | DOAJ |
| description | Background and PurposeWith 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.Methods and MaterialsThirty-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.ResultsAfter statistically controlling for confounding variables such as age, gender, and total intracranial volume, hippocampal atrophy was found after both WBRT and HA-WBRT (p < 10−6). However, hippocampal decline across time following HA-WBRT was approximately three times lower than following conventional WBRT (p < 10−6), with an average atrophy of 3.1% versus 8.5% in the first 2 years after radiation therapy, respectively.ConclusionHA-WBRT is a therapeutic option for patients with multiple brain metastases, which can effectively and durably minimize hippocampal atrophy compared to conventional WBRT. |
| first_indexed | 2024-12-16T06:26:12Z |
| format | Article |
| id | doaj.art-68cbcf7fbab34ce4b7835ac391f3e2b0 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-16T06:26:12Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-68cbcf7fbab34ce4b7835ac391f3e2b02022-12-21T22:41:00ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-08-011110.3389/fonc.2021.714709714709Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal VolumeIlinca Popp0Alexander Rau1Elias Kellner2Marco Reisert3Jamina Tara Fennell4Thomas Rothe5Carsten Nieder6Carsten Nieder7Horst Urbach8Karl Egger9Anca Ligia Grosu10Anca Ligia Grosu11Christoph P. Kaller12Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyMedical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyMedical Physics, Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Oncology and Palliative Medicine, Nordland Hospital, Bodø, NorwayDepartment of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, NorwayDepartment of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyGerman Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, GermanyBackground and PurposeWith 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.Methods and MaterialsThirty-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.ResultsAfter statistically controlling for confounding variables such as age, gender, and total intracranial volume, hippocampal atrophy was found after both WBRT and HA-WBRT (p < 10−6). However, hippocampal decline across time following HA-WBRT was approximately three times lower than following conventional WBRT (p < 10−6), with an average atrophy of 3.1% versus 8.5% in the first 2 years after radiation therapy, respectively.ConclusionHA-WBRT is a therapeutic option for patients with multiple brain metastases, which can effectively and durably minimize hippocampal atrophy compared to conventional WBRT.https://www.frontiersin.org/articles/10.3389/fonc.2021.714709/fullhippocampusatrophyWBRT (whole-brain radiation therapy)cognitive functionMRI |
| spellingShingle | Ilinca Popp Alexander Rau Elias Kellner Marco Reisert Jamina Tara Fennell Thomas Rothe Carsten Nieder Carsten Nieder Horst Urbach Karl Egger Anca Ligia Grosu Anca Ligia Grosu Christoph P. Kaller Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume Frontiers in Oncology hippocampus atrophy WBRT (whole-brain radiation therapy) cognitive function MRI |
| title | Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume |
| title_full | Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume |
| title_fullStr | Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume |
| title_full_unstemmed | Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume |
| title_short | Hippocampus-Avoidance Whole-Brain Radiation Therapy Is Efficient in the Long-Term Preservation of Hippocampal Volume |
| title_sort | hippocampus avoidance whole brain radiation therapy is efficient in the long term preservation of hippocampal volume |
| topic | hippocampus atrophy WBRT (whole-brain radiation therapy) cognitive function MRI |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.714709/full |
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