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Wiegreffe S, Sarria GR, Layer JP, Dejonckheere E, Nour Y, Schmeel FC, Anton Giordano F, Schmeel LC, Popp I, Grosu AL, Gkika E, Stefaan Dejonckheere C. Incidence of hippocampal and perihippocampal brain metastases and impact on hippocampal-avoiding radiotherapy: A systematic review and meta-analysis. Radiother Oncol 2024; 197:110331. [PMID: 38772476 DOI: 10.1016/j.radonc.2024.110331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND AND PURPOSE In patients requiring prophylactic cranial irradiation (PCI) or whole-brain radiotherapy (WBRT) for brain metastases (BMs), hippocampal avoidance (HA) has been shown to preserve neurocognitive function and quality of life. Here, we aim to estimate the incidence of hippocampal and perihippocampal BMs and the subsequent risk of local undertreatment in patients undergoing hippocampal sparing radiotherapy. MATERIALS AND METHODS MEDLINE, Embase, and Scopus were searched with the terms "Hippocampus", "Brain Neoplasms", and related terms. Trials reporting on the incidence of hippocampal and/or perihippocampal BMs or hippocampal failure rate after PCI or WBRT were included. RESULTS Forty records were included, encompassing a total of 5,374 patients with over 32,570 BMs. Most trials employed a 5 mm margin to define the HA zone. In trials reporting on BM incidence, 4.4 % (range 0 - 27 %) and 9.2 % (3 - 41 %) of patients had hippocampal and perihippocampal BMs, respectively. The most common risk factor for hippocampal BMs was the total number of BMs. The reported failure rate within the HA zone after HA-PCI or HA-WBRT was 4.5 % (0 - 13 %), salvageable with radiosurgery in most cases. SCLC histology was not associated with a higher risk of hippocampal failure (OR = 2.49; p = 0.23). In trials comparing with a conventional (non-HA) PCI or WBRT group, HA did not increase the hippocampal failure rate (OR = 1.90; p = 0.17). CONCLUSION The overall incidence of hippocampal and perihippocampal BMs is considerably low, with a subsequent low risk of local undertreatment following HA-PCI or HA-WBRT. In patients without involvement, the hippocampus should be spared to preserve neurocognitive function and quality of life.
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Affiliation(s)
- Shari Wiegreffe
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany; Institute of Experimental Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioural Sciences, 5037 Tilburg, the Netherlands
| | - Younèss Nour
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Frank Anton Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, 68167 Mannheim, Germany; DKFZ-Hector Cancer Institute, University Medical Center Mannheim, 68167 Mannheim, Germany
| | | | - Ilinca Popp
- Department of Radiation Oncology, Medical Faculty, University Freiburg, 79106 Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Faculty, University Freiburg, 79106 Freiburg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany
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Liu J, Wang A, Zhang X, You X, Wang Y. The effect of nursing intervention combined with PD-1 inhibitor on platelets, white blood cells, tumor markers and quality of life in patients with lung cancer. Biotechnol Genet Eng Rev 2023:1-15. [DOI: 10.1080/02648725.2023.2195257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Xie P, Qiao H, Hu H, Xin W, Zhang H, Lan N, Chen X, Ma Y. The Risk of Hippocampal Metastasis and the Associated High-Risk Factors in 411 Patients With Brain Metastases. Front Oncol 2022; 12:808443. [PMID: 35237516 PMCID: PMC8882759 DOI: 10.3389/fonc.2022.808443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsTo retrospectively analyze the incidence of hippocampal metastasis and the associated high-risk factors in patients with brain metastases and evaluate the safety of hippocampal avoidance whole-brain radiation therapy (HA-WBRT).MethodsWe retrospectively analyzed the data of patients with brain metastases diagnosed by contrast-enhanced cranial Magnetic resonance imaging (MRI) at the First Hospital of Lanzhou University from 2017 to 2020. The boundaries of the hippocampus, hippocampus + 5 mm area, hippocampus + 10 mm area, and hippocampus + 20 mm area were delineated, and the distances from the brain metastases to the hippocampus were measured. Univariate and multivariate logistic regressions were adopted to analyze the high-risk factors of hippocampal metastasis.ResultsA total of 3,375 brain metastases in 411 patients were included in the analysis. The metastasis rates in the hippocampus and surrounding areas of the entire group were as follows: 7.3% (30/411) in the hippocampus, 16.5% (68/411) in the hippocampus + 5 mm area, 23.8% (98/411) in the hippocampus + 10 mm area, and 36.5% (150/411) in the hippocampus + 20 mm area. Univariate logistic regression showed that the pathological type, the number of metastases, the maximum diameter of metastases, and the volume of brain metastases were all correlated with hippocampal metastasis. Multivariate logistic regression showed that the pathological type, the number of metastases, and the total volume of metastases were correlated with hippocampal metastasis.ConclusionThe pathological type, the number of metastases, and the total volume of metastases are the high-risk factors associated with hippocampal metastasis. Small cell lung cancer (SCLC) has a significantly higher rate of hippocampal metastasis than other tumor types. The greater the number and total volume of metastases, the more likely the hippocampal metastasis. For patients with SCLC or a greater number and total volume of brain metastases, the implementation of HA-WBRT may bring a higher risk of tumor recurrence.
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Affiliation(s)
- Peng Xie
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hui Qiao
- Department of Oncology, The First Hospital of Lanzhou University, Lanzhou, China
- *Correspondence: Hui Qiao,
| | - Huiling Hu
- Department of Radiology, The First People’s Hospital of Lanzhou City, Lanzhou, China
| | - Wenlong Xin
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Huanyu Zhang
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ning Lan
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaohua Chen
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yan Ma
- Department of Radiation Oncology, The First Hospital of Lanzhou University, Lanzhou, China
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