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Hippocampus-avoidance whole-brain radiation therapy with a simultaneous integrated boost for multiple brain
Ilinca Popp1, Stephan Rau1, Mandy Hintz1
1Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Cancer
|March 7, 2020
Summary
Hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost (HA-WBRT+SIB) shows improved local tumor control and survival for multiple brain metastases. This advanced radiation technique offers a promising therapeutic option with reduced neurologic death rates.
Area of Science:
- Radiation Oncology
- Neurosurgery
- Medical Physics
Background:
- Whole-brain radiation therapy (WBRT) is a standard treatment for multiple brain metastases.
- Conventional WBRT can lead to significant neurocognitive deficits.
- There is a need for radiation techniques that improve tumor control while minimizing toxicity.
Purpose of the Study:
- To investigate the feasibility of hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost (HA-WBRT+SIB).
- To assess tumor control and survival outcomes compared to conventional WBRT.
- To evaluate the efficacy of HA-WBRT+SIB in patients with multiple brain metastases.
Main Methods:
- A monocentric feasibility trial treated 66 patients with HA-WBRT+SIB.
- HA-WBRT+SIB involved delivering radiation to the whole brain while avoiding the hippocampus, with a simultaneous integrated boost to metastases/resection cavities.
- Propensity score matching was used to compare outcomes with a retrospective cohort treated with conventional WBRT.
Main Results:
- HA-WBRT+SIB demonstrated significantly higher local tumor control (98% vs 82% at 1 year) compared to WBRT.
- Patients receiving HA-WBRT+SIB had significantly better intracranial progression-free survival (13.5 vs 6.4 months) and overall survival (9.9 vs 6.2 months).
- The neurologic death rate was lower in the HA-WBRT+SIB group (27.4%).
Conclusions:
- HA-WBRT+SIB is an effective therapeutic option for multiple brain metastases, improving local tumor control and survival.
- This technique offers a reduction in neurologic death rates and an acceptable risk of radiation necrosis.
- HA-WBRT+SIB has the potential to prevent neurocognitive adverse effects, warranting further investigation.
