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01-05-2020 | NSCLC | Clinical Study

Early experience with hippocampal avoidance whole brain radiation therapy and simultaneous integrated boost for brain metastases

Authors: Emily S. Lebow, William L. Hwang, Stephen Zieminski, Yi Wang, Andrzej Niemierko, William A. Mehan Jr, Kevin S. Oh, Melin Khandekar, Henning Willers, Helen A. Shih

Published in: Journal of Neuro-Oncology | Issue 1/2020

Abstract

Purpose

Cranial irradiation results in cognitive decline, which is hypothesized to be partially attributable to hippocampal injury and stem cell loss. Recent advances allow for targeted reduction of radiation dose to the hippocampi while maintaining adequate dose coverage to the brain parenchyma and additional increasing dose to brain metastases, a approach called hippocampal avoidance whole brain radiation therapy with a simultaneous integrated boost (HA-WBRT + SIB.) We review our early clinical experience with HA-WBRT + SIB.

Materials and methods

We evaluated treatments and clinical outcomes for patients treated with HA-WBRT + SIB between 2014 and 2018.

Results

A total of 32 patients (median age, 63.5 years, range 45.3–78.8 years) completed HA-WBRT + SIB. Median follow-up for patients alive at the time of analysis was 11.3 months. The most common histology was non-small cell lung cancer (n = 22). Most patients (n = 25) were prescribed with WBRT dose of 30 Gy with SIB to 37.5 Gy in 15 fractions. Volumetric modulated arc therapy reduced treatment time (p < 0.0001). Median freedom from intracranial progression and overall survival from completion of treatment were 11.4 months and 19.6 months, respectively. Karnofsky Performance Status was associated with improved survival (p = 0.008). The most common toxicities were alopecia, fatigue, and nausea. Five patients developed cognitive impairment, including grade 1 (n = 3), grade 2 (n = 1), and grade 3 (n = 1).

Conclusion

HA-WBRT + SIB demonstrated durable intracranial disease control with modest side effects and merits further investigation as a means of WBRT toxicity reduction while improving long-term locoregional control in the brain.

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Title: Early experience with hippocampal avoidance whole brain radiation therapy and simultaneous integrated boost for brain metastases
Authors: Emily S. Lebow
William L. Hwang
Stephen Zieminski
Yi Wang
Andrzej Niemierko
William A. Mehan Jr
Kevin S. Oh
Melin Khandekar
Henning Willers
Helen A. Shih
Publication date: 01-05-2020
Publisher: Springer US
Keywords: NSCLC
Metastasis
NSCLC
Published in: Journal of Neuro-Oncology / Issue 1/2020
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-020-03491-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early experience with hippocampal avoidance whole brain radiation therapy and simultaneous integrated boost for brain metastases

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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