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Hippocampal Avoidance in Multitarget Radiosurgery.

Zachary Gude1, Justus Adamson2, John P Kirkpatrick3

  • 1Radiation Therapy, Duke University, Durham, USA.

Cureus
|July 12, 2021
PubMed
Summary
This summary is machine-generated.

Stereotactic radiosurgery (SRS) can treat multiple brain metastases, but hippocampal sparing is crucial. High-definition (HD) multileaf collimators (MLCs) significantly reduce radiation dose to the hippocampus compared to standard-definition (SD) MLCs, improving treatment safety.

Keywords:
brain metastaseshd mlc leaveshippocampal avoidancehippocampusradiosurgerysimtvmat

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Area of Science:

  • Radiation Oncology
  • Neuro-oncology
  • Medical Physics

Background:

  • Brain metastases are a frequent complication of cancer, necessitating effective treatment strategies.
  • Stereotactic radiosurgery (SRS) is increasingly used for multiple brain metastases (≥4), raising concerns about neurocognition and quality of life (QOL).
  • Hippocampal avoidance is critical to mitigate long-term neurocognitive effects in SRS patients.

Purpose of the Study:

  • To evaluate the feasibility of hippocampal avoidance in SRS patients undergoing single-isocenter multitarget treatments (SIMT) with volumetric modulated arc therapy (VMAT).
  • To analyze the impact of standard-definition (SD) versus high-definition (HD) multileaf collimators (MLCs) on treatment plan quality and hippocampal dose.
  • To assess the relationship between hippocampal dose constraints and the proximity of planning target volumes (PTVs).

Main Methods:

  • Retrospective analysis of 40 patients with 4-10 brain metastases treated with SIMT-VMAT.
  • Evaluation of hippocampal dose constraints (RTOG 0933 BED limits) with and without optimization for hippocampal avoidance.
  • Comparison of treatment plans using SD-MLCs (5 mm width) versus HD-MLCs.

Main Results:

  • Initial plans exceeded hippocampal dose constraints in 8/40 patients; re-optimization with arc angle adjustment improved compliance.
  • HD-MLCs reduced maximum biologically effective dose (BED) to hippocampi by 29% compared to SD-MLCs (p=0.007).
  • SD-MLCs significantly increased normal brain tissue dose (V50% by 23.67%) and mean hippocampal dose (by 38.0%) in non-optimized plans compared to HD-MLCs.

Conclusions:

  • Hippocampal avoidance is feasible with SIMT-VMAT, particularly when incorporating specific optimization strategies.
  • HD-MLCs offer superior hippocampal dose sparing and reduced normal tissue irradiation compared to SD-MLCs.
  • Treatment plan quality and hippocampal sparing are influenced by the distance between the hippocampus and PTVs.