Distribution of Brain Metastases in Relation to the Hippocampus: Implications for Neurocognitive Functional Preservation

Amol Ghia, Wolfgang A. Tome, Sayana Thomas, George Cannon, Deepak Khuntia, John S. Kuo, Minesh P. Mehta

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Purpose: With the advent of intensity-modulated radiotherapy, the ability to limit the radiation dose to normal tissue offers an avenue to limit side effects. This study attempted to delineate the distribution of brain metastases with relation to the hippocampus for the purpose of exploring the viability of tomotherapy-guided hippocampal sparing therapy potentially to reduce neurocognitive deficits from radiation. Methods and Materials: The pre-radiotherapy T1-weighted, postcontrast axial MR images of 100 patients who received whole brain radiotherapy, stereotactic radiosurgery, or a radiosurgical boost following whole brain radiotherapy between 2002 and 2006 were examined. We contoured brain metastases as well as hippocampi with 5-, 10-, and 15-mm expansion envelopes. Results: Of the 272 identified metastases, 3.3% (n = 9) were within 5 mm of the hippocampus, and 86.4% of metastases were greater than 15 mm from the hippocampus (n = 235). The most common location for metastatic disease was the frontal lobe (31.6%, n = 86). This was followed by the cerebellum (24.3%, n = 66), parietal lobe (16.9%, n = 46), temporal lobe (12.9%, n = 35), occipital lobe (7.7%, n = 21), deep brain nuclei (4.0%, n = 11), and brainstem (2.6%, n = 7). Conclusions: Of the 100 patients, 8 had metastases within 5 mm of the hippocampus. Hence, a 5-mm margin around the hippocampus for conformal avoidance whole brain radiotherapy represents an acceptable risk, especially because these patients in the absence of any other intracranial disease could be salvaged using stereotactic radiosurgery. Moreover, we developed a hippocampal sparing tomotherapy plan as proof of principle to verify the feasibility of this therapy in the setting of brain metastases.

Original languageEnglish (US)
Pages (from-to)971-977
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume68
Issue number4
DOIs
StatePublished - Jul 15 2007
Externally publishedYes

Fingerprint

hippocampus
metastasis
brain
Hippocampus
Neoplasm Metastasis
radiation therapy
Brain
Radiotherapy
lobes
Radiosurgery
occipital lobes
therapy
cerebellum
Radiation
Intensity-Modulated Radiotherapy
Occipital Lobe
Parietal Lobe
avoidance
Frontal Lobe
Temporal Lobe

Keywords

  • Brain metastases
  • Distribution
  • Hippocampus
  • IMRT
  • Neurocognition
  • Tomotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Distribution of Brain Metastases in Relation to the Hippocampus : Implications for Neurocognitive Functional Preservation. / Ghia, Amol; Tome, Wolfgang A.; Thomas, Sayana; Cannon, George; Khuntia, Deepak; Kuo, John S.; Mehta, Minesh P.

In: International Journal of Radiation Oncology Biology Physics, Vol. 68, No. 4, 15.07.2007, p. 971-977.

Research output: Contribution to journalArticle

Ghia, Amol ; Tome, Wolfgang A. ; Thomas, Sayana ; Cannon, George ; Khuntia, Deepak ; Kuo, John S. ; Mehta, Minesh P. / Distribution of Brain Metastases in Relation to the Hippocampus : Implications for Neurocognitive Functional Preservation. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 68, No. 4. pp. 971-977.
@article{928616309760465b8a17f749bbcbbdaa,
title = "Distribution of Brain Metastases in Relation to the Hippocampus: Implications for Neurocognitive Functional Preservation",
abstract = "Purpose: With the advent of intensity-modulated radiotherapy, the ability to limit the radiation dose to normal tissue offers an avenue to limit side effects. This study attempted to delineate the distribution of brain metastases with relation to the hippocampus for the purpose of exploring the viability of tomotherapy-guided hippocampal sparing therapy potentially to reduce neurocognitive deficits from radiation. Methods and Materials: The pre-radiotherapy T1-weighted, postcontrast axial MR images of 100 patients who received whole brain radiotherapy, stereotactic radiosurgery, or a radiosurgical boost following whole brain radiotherapy between 2002 and 2006 were examined. We contoured brain metastases as well as hippocampi with 5-, 10-, and 15-mm expansion envelopes. Results: Of the 272 identified metastases, 3.3{\%} (n = 9) were within 5 mm of the hippocampus, and 86.4{\%} of metastases were greater than 15 mm from the hippocampus (n = 235). The most common location for metastatic disease was the frontal lobe (31.6{\%}, n = 86). This was followed by the cerebellum (24.3{\%}, n = 66), parietal lobe (16.9{\%}, n = 46), temporal lobe (12.9{\%}, n = 35), occipital lobe (7.7{\%}, n = 21), deep brain nuclei (4.0{\%}, n = 11), and brainstem (2.6{\%}, n = 7). Conclusions: Of the 100 patients, 8 had metastases within 5 mm of the hippocampus. Hence, a 5-mm margin around the hippocampus for conformal avoidance whole brain radiotherapy represents an acceptable risk, especially because these patients in the absence of any other intracranial disease could be salvaged using stereotactic radiosurgery. Moreover, we developed a hippocampal sparing tomotherapy plan as proof of principle to verify the feasibility of this therapy in the setting of brain metastases.",
keywords = "Brain metastases, Distribution, Hippocampus, IMRT, Neurocognition, Tomotherapy",
author = "Amol Ghia and Tome, {Wolfgang A.} and Sayana Thomas and George Cannon and Deepak Khuntia and Kuo, {John S.} and Mehta, {Minesh P.}",
year = "2007",
month = "7",
day = "15",
doi = "10.1016/j.ijrobp.2007.02.016",
language = "English (US)",
volume = "68",
pages = "971--977",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Distribution of Brain Metastases in Relation to the Hippocampus

T2 - Implications for Neurocognitive Functional Preservation

AU - Ghia, Amol

AU - Tome, Wolfgang A.

AU - Thomas, Sayana

AU - Cannon, George

AU - Khuntia, Deepak

AU - Kuo, John S.

AU - Mehta, Minesh P.

PY - 2007/7/15

Y1 - 2007/7/15

N2 - Purpose: With the advent of intensity-modulated radiotherapy, the ability to limit the radiation dose to normal tissue offers an avenue to limit side effects. This study attempted to delineate the distribution of brain metastases with relation to the hippocampus for the purpose of exploring the viability of tomotherapy-guided hippocampal sparing therapy potentially to reduce neurocognitive deficits from radiation. Methods and Materials: The pre-radiotherapy T1-weighted, postcontrast axial MR images of 100 patients who received whole brain radiotherapy, stereotactic radiosurgery, or a radiosurgical boost following whole brain radiotherapy between 2002 and 2006 were examined. We contoured brain metastases as well as hippocampi with 5-, 10-, and 15-mm expansion envelopes. Results: Of the 272 identified metastases, 3.3% (n = 9) were within 5 mm of the hippocampus, and 86.4% of metastases were greater than 15 mm from the hippocampus (n = 235). The most common location for metastatic disease was the frontal lobe (31.6%, n = 86). This was followed by the cerebellum (24.3%, n = 66), parietal lobe (16.9%, n = 46), temporal lobe (12.9%, n = 35), occipital lobe (7.7%, n = 21), deep brain nuclei (4.0%, n = 11), and brainstem (2.6%, n = 7). Conclusions: Of the 100 patients, 8 had metastases within 5 mm of the hippocampus. Hence, a 5-mm margin around the hippocampus for conformal avoidance whole brain radiotherapy represents an acceptable risk, especially because these patients in the absence of any other intracranial disease could be salvaged using stereotactic radiosurgery. Moreover, we developed a hippocampal sparing tomotherapy plan as proof of principle to verify the feasibility of this therapy in the setting of brain metastases.

AB - Purpose: With the advent of intensity-modulated radiotherapy, the ability to limit the radiation dose to normal tissue offers an avenue to limit side effects. This study attempted to delineate the distribution of brain metastases with relation to the hippocampus for the purpose of exploring the viability of tomotherapy-guided hippocampal sparing therapy potentially to reduce neurocognitive deficits from radiation. Methods and Materials: The pre-radiotherapy T1-weighted, postcontrast axial MR images of 100 patients who received whole brain radiotherapy, stereotactic radiosurgery, or a radiosurgical boost following whole brain radiotherapy between 2002 and 2006 were examined. We contoured brain metastases as well as hippocampi with 5-, 10-, and 15-mm expansion envelopes. Results: Of the 272 identified metastases, 3.3% (n = 9) were within 5 mm of the hippocampus, and 86.4% of metastases were greater than 15 mm from the hippocampus (n = 235). The most common location for metastatic disease was the frontal lobe (31.6%, n = 86). This was followed by the cerebellum (24.3%, n = 66), parietal lobe (16.9%, n = 46), temporal lobe (12.9%, n = 35), occipital lobe (7.7%, n = 21), deep brain nuclei (4.0%, n = 11), and brainstem (2.6%, n = 7). Conclusions: Of the 100 patients, 8 had metastases within 5 mm of the hippocampus. Hence, a 5-mm margin around the hippocampus for conformal avoidance whole brain radiotherapy represents an acceptable risk, especially because these patients in the absence of any other intracranial disease could be salvaged using stereotactic radiosurgery. Moreover, we developed a hippocampal sparing tomotherapy plan as proof of principle to verify the feasibility of this therapy in the setting of brain metastases.

KW - Brain metastases

KW - Distribution

KW - Hippocampus

KW - IMRT

KW - Neurocognition

KW - Tomotherapy

UR - http://www.scopus.com/inward/record.url?scp=34447277878&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447277878&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2007.02.016

DO - 10.1016/j.ijrobp.2007.02.016

M3 - Article

C2 - 17446005

AN - SCOPUS:34447277878

VL - 68

SP - 971

EP - 977

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 4

ER -