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Open Access 01-12-2015 | Research

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

Authors: Anand Mahadevan, Carrie Sampson, Salvatore LaRosa, Scott R. Floyd, Eric T. Wong, Erik J. Uhlmann, Soma Sengupta, Ekkehard M. Kasper

Published in: Radiation Oncology | Issue 1/2015

Abstract

Background

Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia.

Methods

Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means.

Results

All six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V₂₄ (9 cc vs. 44 cc, p < 0.0000) and V₃₀ (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area.

Conclusions

HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia.

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Title: Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy
Authors: Anand Mahadevan
Carrie Sampson
Salvatore LaRosa
Scott R. Floyd
Eric T. Wong
Erik J. Uhlmann
Soma Sengupta
Ekkehard M. Kasper
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-015-0555-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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