TY - JOUR
T1 - Estimated risk of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy
T2 - Safety profile for RTOG 0933
AU - Gondi, Vinai
AU - Tome, Wolfgang A.
AU - Marsh, James
AU - Struck, Aaron
AU - Ghia, Amol
AU - Turian, Julius V.
AU - Bentzen, Søren M.
AU - Kuo, John S.
AU - Khuntia, Deepak
AU - Mehta, Minesh P.
PY - 2010/6
Y1 - 2010/6
N2 - Background and purpose: RTOG 0933 is a phase II clinical trial of hippocampal avoidance during whole-brain radiotherapy (HA-WBRT) to prevent radiation-induced neurocognitive decline. By quantifying baseline incidence of perihippocampal or hippocampal metastasis, we sought to estimate the risk of developing metastases in the hippocampal avoidance region (the hippocampus plus 5 mm margin). Materials/methods: Patients with ≤10 brain metastases treated at two separate institutions were reviewed. Axial images from pre-treatment, post-contrast MRIs were used to contour each metastasis and hippocampus according to a published protocol. Clinical and radiographic variables were correlated with perihippocampal metastasis using a binary logistical regression analysis, with two-sided p < 0.05 for statistical significance. Results: 1133 metastases were identified in 371 patients. Metastases within 5 mm of the hippocampus were observed in 8.6% of patients (95% CI 5.7-11.5%) and 3.0% of brain metastases. None of the metastases lay within the hippocampus. A 1-cm3 increase in the aggregate volume of intra-cranial metastatic disease was associated with an odds ratio of 1.02 (95% CI 1.006-1.034, p = 0.003) for the presence of perihippocampal metastasis. Conclusion: With an estimated perihippocampal metastasis risk of 8.6%, we deem HA-WBRT safe for clinical testing in patients with brain metastases as part of RTOG 0933.
AB - Background and purpose: RTOG 0933 is a phase II clinical trial of hippocampal avoidance during whole-brain radiotherapy (HA-WBRT) to prevent radiation-induced neurocognitive decline. By quantifying baseline incidence of perihippocampal or hippocampal metastasis, we sought to estimate the risk of developing metastases in the hippocampal avoidance region (the hippocampus plus 5 mm margin). Materials/methods: Patients with ≤10 brain metastases treated at two separate institutions were reviewed. Axial images from pre-treatment, post-contrast MRIs were used to contour each metastasis and hippocampus according to a published protocol. Clinical and radiographic variables were correlated with perihippocampal metastasis using a binary logistical regression analysis, with two-sided p < 0.05 for statistical significance. Results: 1133 metastases were identified in 371 patients. Metastases within 5 mm of the hippocampus were observed in 8.6% of patients (95% CI 5.7-11.5%) and 3.0% of brain metastases. None of the metastases lay within the hippocampus. A 1-cm3 increase in the aggregate volume of intra-cranial metastatic disease was associated with an odds ratio of 1.02 (95% CI 1.006-1.034, p = 0.003) for the presence of perihippocampal metastasis. Conclusion: With an estimated perihippocampal metastasis risk of 8.6%, we deem HA-WBRT safe for clinical testing in patients with brain metastases as part of RTOG 0933.
KW - Brain metastases
KW - Hippocampal avoidance
KW - Neurocognitive function
KW - RTOG 0933
KW - Whole-brain radiotherapy
UR - https://www.scopus.com/pages/publications/77952585016
U2 - 10.1016/j.radonc.2010.02.030
DO - 10.1016/j.radonc.2010.02.030
M3 - Article
C2 - 20392503
AN - SCOPUS:77952585016
SN - 0167-8140
VL - 95
SP - 327
EP - 331
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 3
ER -