Estimated risk of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy: Safety profile for RTOG 0933

Vinai Gondi, Wolfgang A. Tome, James Marsh, Aaron Struck, Amol Ghia, Julius V. Turian, Søren M. Bentzen, John S. Kuo, Deepak Khuntia, Minesh P. Mehta

Research output: Contribution to journalArticle

128 Scopus citations

Abstract

Background and purpose: RTOG 0933 is a phase II clinical trial of hippocampal avoidance during whole-brain radiotherapy (HA-WBRT) to prevent radiation-induced neurocognitive decline. By quantifying baseline incidence of perihippocampal or hippocampal metastasis, we sought to estimate the risk of developing metastases in the hippocampal avoidance region (the hippocampus plus 5 mm margin). Materials/methods: Patients with ≤10 brain metastases treated at two separate institutions were reviewed. Axial images from pre-treatment, post-contrast MRIs were used to contour each metastasis and hippocampus according to a published protocol. Clinical and radiographic variables were correlated with perihippocampal metastasis using a binary logistical regression analysis, with two-sided p < 0.05 for statistical significance. Results: 1133 metastases were identified in 371 patients. Metastases within 5 mm of the hippocampus were observed in 8.6% of patients (95% CI 5.7-11.5%) and 3.0% of brain metastases. None of the metastases lay within the hippocampus. A 1-cm3 increase in the aggregate volume of intra-cranial metastatic disease was associated with an odds ratio of 1.02 (95% CI 1.006-1.034, p = 0.003) for the presence of perihippocampal metastasis. Conclusion: With an estimated perihippocampal metastasis risk of 8.6%, we deem HA-WBRT safe for clinical testing in patients with brain metastases as part of RTOG 0933.

Original languageEnglish (US)
Pages (from-to)327-331
Number of pages5
JournalRadiotherapy and Oncology
Volume95
Issue number3
DOIs
StatePublished - Jun 2010

Keywords

  • Brain metastases
  • Hippocampal avoidance
  • Neurocognitive function
  • RTOG 0933
  • Whole-brain radiotherapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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