May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy?
Abstract Purpose One of the main limiting factors of whole-brain radiation therapy (WBRT) for primary central nervous system lymphoma (PCNSL) is the impairment of neurocognitive functions (NCFs), which is mainly caused by radiation-induced injury to the hippocampus. With a view to preventing NCF imp...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-10-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02251-2 |
| _version_ | 1827709177683771392 |
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| author | Ciro Mazzarella Silvia Chiesa Lucrezia Toppi Stefan Hohaus Simona Gaudino Francesco D’Alo Nicola Dinapoli Resta Davide Tiziano Zinicola Serena Bracci Antonella Martino Francesco Beghella Bartoli Elisabetta Lepre Roberta Bertolini Silvia Mariani Cesare Colosimo Vincenzo Frascino Gian Carlo Mattiucci Maria Antonietta Gambacorta Vincenzo Valentini Mario Balducci |
| author_facet | Ciro Mazzarella Silvia Chiesa Lucrezia Toppi Stefan Hohaus Simona Gaudino Francesco D’Alo Nicola Dinapoli Resta Davide Tiziano Zinicola Serena Bracci Antonella Martino Francesco Beghella Bartoli Elisabetta Lepre Roberta Bertolini Silvia Mariani Cesare Colosimo Vincenzo Frascino Gian Carlo Mattiucci Maria Antonietta Gambacorta Vincenzo Valentini Mario Balducci |
| author_sort | Ciro Mazzarella |
| collection | DOAJ |
| description | Abstract Purpose One of the main limiting factors of whole-brain radiation therapy (WBRT) for primary central nervous system lymphoma (PCNSL) is the impairment of neurocognitive functions (NCFs), which is mainly caused by radiation-induced injury to the hippocampus. With a view to preventing NCF impairment and personalizing treatment, we explored the feasibility of sparing the hippocampus during WBRT by correlating the sites of PCNSL lesions with the hippocampus. Methods and materials Pre-treatment MR images from patients who underwent WBRT between 2010 and January 2020—and post-radiotherapy images in cases of relapse—were imported into the Varian Eclipse treatment-planning system and registered with the simulation CT. We constructed three 3-dimensional envelopes around the hippocampus at distances of 5, 10 and 15 mm and also contoured primary lesions and recurrences. Results We analyzed 43 patients with 66 primary lesions: 9/66 (13.6%) involved the hippocampus and 11/66 (16.7%) were located within 5 mm of it. Thirty-six lesions (54.5%) were situated more than 15 mm from the hippocampus, while 10/66 (15.2%) were between 5 and 15 mm from it. The most common location was in deep brain structures (31%). Thirty-five of the 66 lesions relapsed: in field in 14/35 (40%) and outfield in 21/35 (60%) in different sites. Globally, 16/35 recurrences (45.7%) were located in the hippocampus or within 5 mm of it. Conclusion These data show that routinely sparing the hippocampus is not feasible. This approach could be considered in selected patients, when the lesion is more than 15 mm from the hippocampus. |
| first_indexed | 2024-03-10T17:18:19Z |
| format | Article |
| id | doaj.art-7ab992142d2240e79ef9847a4cf096c4 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-10T17:18:19Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-7ab992142d2240e79ef9847a4cf096c42023-11-20T10:26:30ZengBMCRadiation Oncology1748-717X2023-10-011811610.1186/s13014-023-02251-2May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy?Ciro Mazzarella0Silvia Chiesa1Lucrezia Toppi2Stefan Hohaus3Simona Gaudino4Francesco D’Alo5Nicola Dinapoli6Resta Davide7Tiziano Zinicola8Serena Bracci9Antonella Martino10Francesco Beghella Bartoli11Elisabetta Lepre12Roberta Bertolini13Silvia Mariani14Cesare Colosimo15Vincenzo Frascino16Gian Carlo Mattiucci17Maria Antonietta Gambacorta18Vincenzo Valentini19Mario Balducci20UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCSUOC di Neuroradiologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCSUOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCSUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCSUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliIstituto di Radiologia, Università Cattolica del Sacro CuoreUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo A. GemelliAbstract Purpose One of the main limiting factors of whole-brain radiation therapy (WBRT) for primary central nervous system lymphoma (PCNSL) is the impairment of neurocognitive functions (NCFs), which is mainly caused by radiation-induced injury to the hippocampus. With a view to preventing NCF impairment and personalizing treatment, we explored the feasibility of sparing the hippocampus during WBRT by correlating the sites of PCNSL lesions with the hippocampus. Methods and materials Pre-treatment MR images from patients who underwent WBRT between 2010 and January 2020—and post-radiotherapy images in cases of relapse—were imported into the Varian Eclipse treatment-planning system and registered with the simulation CT. We constructed three 3-dimensional envelopes around the hippocampus at distances of 5, 10 and 15 mm and also contoured primary lesions and recurrences. Results We analyzed 43 patients with 66 primary lesions: 9/66 (13.6%) involved the hippocampus and 11/66 (16.7%) were located within 5 mm of it. Thirty-six lesions (54.5%) were situated more than 15 mm from the hippocampus, while 10/66 (15.2%) were between 5 and 15 mm from it. The most common location was in deep brain structures (31%). Thirty-five of the 66 lesions relapsed: in field in 14/35 (40%) and outfield in 21/35 (60%) in different sites. Globally, 16/35 recurrences (45.7%) were located in the hippocampus or within 5 mm of it. Conclusion These data show that routinely sparing the hippocampus is not feasible. This approach could be considered in selected patients, when the lesion is more than 15 mm from the hippocampus.https://doi.org/10.1186/s13014-023-02251-2PCNSLHippocampal sparingWBRTIMRTNeuro-toxicityPersonalized treatment |
| spellingShingle | Ciro Mazzarella Silvia Chiesa Lucrezia Toppi Stefan Hohaus Simona Gaudino Francesco D’Alo Nicola Dinapoli Resta Davide Tiziano Zinicola Serena Bracci Antonella Martino Francesco Beghella Bartoli Elisabetta Lepre Roberta Bertolini Silvia Mariani Cesare Colosimo Vincenzo Frascino Gian Carlo Mattiucci Maria Antonietta Gambacorta Vincenzo Valentini Mario Balducci May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? Radiation Oncology PCNSL Hippocampal sparing WBRT IMRT Neuro-toxicity Personalized treatment |
| title | May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? |
| title_full | May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? |
| title_fullStr | May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? |
| title_full_unstemmed | May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? |
| title_short | May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? |
| title_sort | may we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy |
| topic | PCNSL Hippocampal sparing WBRT IMRT Neuro-toxicity Personalized treatment |
| url | https://doi.org/10.1186/s13014-023-02251-2 |
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