Abstract
Radiation treatment techniques for whole-brain radiation therapy (WBRT) have not changed significantly since development of the procedure. However, the recent development of novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) and helical tomotherapy, as well as an increasing body of evidence concerning neural stem cells (NSCs) have altered the conventional WBRT treatment paradigm. In this regard, hippocampus-sparing WBRT is a novel technique that aims to spare critical hippocampus regions without compromising tumour control. Published data on this new technique are limited to planning and feasibility studies; data on patient outcome are still lacking. However, several prospective trials to analyse the feasibility of this technique and to document clinical outcome in terms of reduced neurotoxicity are ongoing.
Zusammenfassung
Die Technik der Ganzhirnbestrahlung („whole-brain radiation therapy“, WBRT) hat sich seit der Entwicklung nicht wesentlich verändert. Allerdings stellten die Neuentwicklung von Techniken wie die intensitätsmodulierte Strahlentherapie (IMRT), die volumenmodulierte Arc-Therapie (VMAT) oder die helikale Tomotherapie sowie immer größeres Wissen über das neurale Stammzellkompartiment (NSCs) das herkömmliche Ganzhirn-Paradigma in Frage. Die hippocampusschonende Ganzhirnbestrahlung ist eine neuartige Technik, welche die kritische Region des Hippocampus schont, ohne die Tumorkontrolle zu gefährden. Über diese Technik gibt es bisher nur eine begrenzte Datenlage im Sinne von Planungs- und Machbarkeitsstudien. Klinische Daten bzgl. der Behandlungsergebnisse fehlen nach wie vor, aber einige prospektive Studien sind im Gange, um nicht nur die Machbarkeit zu belegen, sondern auch das klinische Outcome im Sinne einer verringerten Neurotoxizität nachzuweisen.
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References
Aoyama H, Shirato H, Tago M et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491
Barani IJ, Benedict SH, Lin PS (2007) Neural stem cells: implications for the conventional radiotherapy of central nervous system malignancies. Int J Radiat Oncol Biol Phys 68:324–333
Belarbi K, Jopson T, Arellano C et al (2013) CCR2 Deficiency prevents neuronal dysfunction and cognitive impairments induced by cranial irradiation. Cancer Res 73:1201–1210
Blomstrand M, Brodin NP, Munck Af Rosenschold P et al (2012) Estimated clinical benefit of protecting neurogenesis in the develo** brain during radiation therapy for pediatric medulloblastoma. Neuro Oncol 14:882–889
Chang EL, Wefel JS, Hess KR et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044
Chen XJ, **ao JP, Li XP et al (2011) Risk factors of distant brain failure for patients with newly diagnosed brain metastases treated with stereotactic radiotherapy alone. Radiat Oncol 6:175
Cole AM, Scherwath A, Ernst G et al (2013) Self-reported cognitive outcomes in patients with brain metastases before and after radiation therapy. Int J Radiat Oncol Biol Phys 78:705–712
DeAngelis LM, Mandell LR, Thaler HT et al (1989) The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery 24:798–805
Franco P, Numico G, Migliaccio F et al (2012) Head and neck region consolidation radiotherapy and prophylactic cranial irradiation with hippocampal avoidance delivered with helical tomotherapy after induction chemotherapy for non-sinonasal neuroendocrine carcinoma of the upper airways. Radiat Oncol 7:21
Fuss M, Poljanc K, Miller DW et al (200) Normal tissue complication probability (NTCP) as a Means to compare proton and photon plans and evaluation appropriateness of calculated values. Int J Cancer (Radiat Oncol Invest) 90:351–358
Ghia A, Tome WA, Thomas S et al (2007) Distribution of brain metastases in relation to the hippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys 68:971–977
Gondi V, Hermann BP, Mehta MP et al (2013) Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors. Int J Radiat Oncol Biol Phys 85:348–354
Gondi V, Tolakanahalli R, Mehta MP et al (2010) Hippocampal-sparing whole-brain radiotherapy: a “how-to” technique using helical tomotherapy and linear accelerator-based intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 78:1244–1252
Gondi V, Tome WA, Marsh J et al (2010) Estimated risk of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy: safety profile for RTOG 0933. Radiother Oncol 95:327–331
Gondi V, Tome WA, Mehta MP (2010) Why avoid the hippocampus? A comprehensive review. Radiother Oncol 97:370–376
Greene-Schloesser D, Moore E, Robbins ME (2013) Molecular pathways: radiation-induced cognitive impairment. Clin Cancer Res 19:2294
Gutierrez AN, Westerly DC, Tome WA et al (2007) Whole brain radiotherapy with hippocampal avoidance and simultaneously integrated brain metastases boost: a planning study. Int J Radiat Oncol Biol Phys 69:589–597
Hsu F, Carolan H, Nichol A et al (2010) Whole brain radiotherapy with hippocampal avoidance and simultaneous integrated boost for 1–3 brain metastases: a feasibility study using volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 76:1480–1485
Kirby N, Chuang C, Pouliot J et al (2011) Physics strategies for sparing neural stem cells during whole-brain radiation treatments. Med Phys 38:5338–5344
Kocher M, Soffietti R, Abacioglu U et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141
Kress MA, Ramakrishna N, Makgoeng SB et al (2012) Physician self-reported treatment of brain metastases according to patients’ clinical and demographic factors and physician practice setting. Radiat Oncol 7:188
Marsh JC, Gielda BT, Herskovic AM (2010) Cognitive Sparing during the administration of whole brain radiotherapy and prophylactic cranial irradiation: current concepts and approaches. J Oncol 2010:198208
Marsh JC, Herskovic AM, Gielda BT et al (2010) Intracranial metastatic disease spares the limibic circuit: a review of 697 metastatic lesions in 107 patients. Int J Radiat Oncol Biol Phys 76:504–512
Patchell RA, Tibbs PA, Regine WF et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489
Prokic V, Wiedenmann N, Fels F et al (2013) Whole brain irradiation with hippocampal sparing and dose escalation on multiple brain metastases: a planning study on treatment concepts. Int J Radiat Oncol Biol Phys 85:264–270
Raber J, Rola R, LeFevour A et al (2004) Radiation-induced cognitive impairments are associated with changes in indicators of hippocampal neurogenesis. Radiat Res 162:39–47
Rades D, Kueter JD, Gliemroth J et al (2012) Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis. Strahlenther Onkol 188:143–147
Rades D, Schild SE (2012) Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery? Strahlenther Onkol 188:702–706
Redmond KJ, Mahone EM, Terezakis S et al (2013) Association between radiation dose to neuronal progenitor cell niches and temporal lobes and performance on neuropsychological testing in children: a prospective study. Neuro Oncol 15:360–369
Scoccianti S, Detti B, Cipressi S et al (2012) Changes in neurocognitive functioning and quality of life in adult patients with brain tumors treated with radiotherapy. J Neurooncol 108:291–308
Scoccianti S, Ricardi U (2012) Treatment of brain metastases: review of phase III randomised controlled trails. Radiother Oncol 102:168–179
Steinmann D, Vordermark D, Geinitz H et al (2013) Proxy assessment of patients before and after radiotherapy for brain metastases. Results of a prospective study using the DEGRO brain module. Strahlenther Onkol 189:47–53
Sun A, Bae K, Gore EM et al (2011) Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer: neurocognitive and quality-of-life analysis. J Clin Oncol 29:279–286
Tallet AV, Azria D, Barlesi F et al (2012) Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment. Radiat Oncol 7:77
Tarnawski R, Michalecki L, Blamek S et al (2011) Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer. Neoplasma 58:507–515
Villa S, Weber DC, Moretones C et al (2011) Validation of the new Graded Prognostic Assessment scale for brain metastases: a multicenter prospective study. Radiat Oncol 6:23
Wan JF, Zhang SJ, Wang L et al (2013) Implications for preserving neural stem cells in whole brain radiotherapy and prophylactic cranial irradiation: a review of 2270 metastases in 488 patients. J Radiat Res 45:285–291
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Conflict of interest. F. Oskan, U. Ganswindt, S.B. Schwarz, F. Manapov, C.Belka and M. Niyazi state that there are no conflicts of interest.
The accompanying manuscript does not include studies on humans or animals.
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Oskan, F., Ganswindt, U., Schwarz, S. et al. Hippocampus sparing in whole-brain radiotherapy. Strahlenther Onkol 190, 337–341 (2014). https://doi.org/10.1007/s00066-013-0518-8
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DOI: https://doi.org/10.1007/s00066-013-0518-8