Núria Rodríguez de Dios1,2,3, Felipe Couñago4, Mauricio Murcia-Mejía5, Mikel Rico-Oses6, Patricia Calvo-Crespo7, Pilar Samper8, Carmen Vallejo9, Javier Luna10, Itziar Trueba11, Amalia Sotoca12, Cristina Cigarral13, Núria Farré14, Rosa M Manero15, Xavier Durán2, Juan Domigo Gispert2,3,16,17, Gonzalo Sánchez-Benavides2,16,18, Teresa Rognoni19, Margarita Torrente20,21, Jaume Capellades22, Mar Jiménez23, Teresa Cabada24, Miguel Blanco25, Ana Alonso26, Juan Martínez-San Millán27, José Escribano28, Beatriz González13, José Luis López-Guerra29. 1. Radiation Oncology, Hospital del Mar, Barcelona, Spain. 2. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 3. Pompeu Fabra University, Barcelona, Spain. 4. Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid, Spain. 5. Department of Radiation Oncology, Hospital Universitario Sant Joan de Reus, Reus, Tarragona, Spain. 6. Department of Radiation Oncology, Complejo Hospitalario Navarra, Pamplona, Spain. 7. Department of Radiation Oncology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. 8. Department of Radiation Oncology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain. 9. Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 10. Department of Radiation Oncology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain. 11. Department of Radiation Oncology, Hospital Universitario de Álava-sede Txagorritxu.Vitoria-Gasteiz, Spain. 12. Department of Radiation Oncology, Hospital Ruber Internacional, Madrid, Spain. 13. Department of Radiation Oncology, Hospital Clínico de Salamanca, Salamanca, Spain. 14. Department of Radiation Oncology, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain. 15. Department of Neurology, Hospital del Mar, Barcelona, Spain. 16. BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain. 17. Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain. 18. Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain. 19. Department of Neurology, Clínica Universidad de Navarrra, Madrid, Spain. 20. Department of Psychology, School of Educational Sciences and Psychology, Rovira i Virgili University, Tarragona, Spain. 21. Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Rovira i Virgili University, Tarragona, Spain. 22. Department of Radiology, Hospital del Mar, Barcelona, Spain. 23. Department of Radiology, Hospital Universitario Quirónsalud, Madrid, Spain. 24. Department of Radiology, Complejo Hospitalario Navarra, Pamplona, Spain. 25. Department of Radiology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. 26. Department of Radiology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain. 27. Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 28. Department of Radiology, Hospital Ruber Internacional, Madrid, Spain. 29. Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Abstract
PURPOSE: Radiation dose received by the neural stem cells of the hippocampus during whole-brain radiotherapy has been associated with neurocognitive decline. The key concern using hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) in patients with small-cell lung cancer (SCLC) is the incidence of brain metastasis within the hippocampal avoidance zone. METHODS: This phase III trial enrolled 150 patients with SCLC (71.3% with limited disease) to standard prophylactic cranial irradiation (PCI; 25 Gy in 10 fractions) or HA-PCI. The primary objective was the delayed free recall (DFR) on the Free and Cued Selective Reminding Test (FCSRT) at 3 months; a decrease of 3 points or greater from baseline was considered a decline. Secondary end points included other FCSRT scores, quality of life (QoL), evaluation of the incidence and location of brain metastases, and overall survival (OS). Data were recorded at baseline, and 3, 6, 12, and 24 months after PCI. RESULTS: Participants' baseline characteristics were well balanced between the two groups. The median follow-up time for living patients was 40.4 months. Decline on DFR from baseline to 3 months was lower in the HA-PCI arm (5.8%) compared with the PCI arm (23.5%; odds ratio, 5; 95% CI, 1.57 to 15.86; P = .003). Analysis of all FCSRT scores showed a decline on the total recall (TR; 8.7% v 20.6%) at 3 months; DFR (11.1% v 33.3%), TR (20.3% v 38.9%), and total free recall (14.8% v 31.5%) at 6 months, and TR (14.2% v 47.6%) at 24 months. The incidence of brain metastases, OS, and QoL were not significantly different. CONCLUSION: Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC. No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.
PURPOSE: Radiation dose received by the neural stem cells of the hippocampus during whole-brain radiotherapy has been associated with neurocognitive decline. The key concern using hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) in patients with small-cell lung cancer (SCLC) is the incidence of brain metastasis within the hippocampal avoidance zone. METHODS: This phase III trial enrolled 150 patients with SCLC (71.3% with limited disease) to standard prophylactic cranial irradiation (PCI; 25 Gy in 10 fractions) or HA-PCI. The primary objective was the delayed free recall (DFR) on the Free and Cued Selective Reminding Test (FCSRT) at 3 months; a decrease of 3 points or greater from baseline was considered a decline. Secondary end points included other FCSRT scores, quality of life (QoL), evaluation of the incidence and location of brain metastases, and overall survival (OS). Data were recorded at baseline, and 3, 6, 12, and 24 months after PCI. RESULTS: Participants' baseline characteristics were well balanced between the two groups. The median follow-up time for living patients was 40.4 months. Decline on DFR from baseline to 3 months was lower in the HA-PCI arm (5.8%) compared with the PCI arm (23.5%; odds ratio, 5; 95% CI, 1.57 to 15.86; P = .003). Analysis of all FCSRT scores showed a decline on the total recall (TR; 8.7% v 20.6%) at 3 months; DFR (11.1% v 33.3%), TR (20.3% v 38.9%), and total free recall (14.8% v 31.5%) at 6 months, and TR (14.2% v 47.6%) at 24 months. The incidence of brain metastases, OS, and QoL were not significantly different. CONCLUSION: Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC. No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.
Authors: Eric J Lehrer; Brianna M Jones; Daniel R Dickstein; Sheryl Green; Isabelle M Germano; Joshua D Palmer; Nadia Laack; Paul D Brown; Vinai Gondi; Jeffrey S Wefel; Jason P Sheehan; Daniel M Trifiletti Journal: Front Oncol Date: 2022-06-30 Impact factor: 5.738
Authors: Paul W Sperduto; Brian De; Jing Li; David Carpenter; John Kirkpatrick; Michael Milligan; Helen A Shih; Tugce Kutuk; Rupesh Kotecha; Hajime Higaki; Manami Otsuka; Hidefumi Aoyama; Malie Bourgoin; David Roberge; Salah Dajani; Sean Sachdev; Jordan Gainey; John M Buatti; William Breen; Paul D Brown; Lisa Ni; Steve Braunstein; Matthew Gallitto; Tony J C Wang; Ryan Shanley; Emil Lou; Jay Shiao; Laurie E Gaspar; Satoshi Tanabe; Toshimichi Nakano; Yi An; Veronica Chiang; Liang Zeng; Hany Soliman; Hesham Elhalawani; Daniel Cagney; Evan Thomas; Drexell H Boggs; Manmeet S Ahluwalia; Minesh P Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2022-03-21 Impact factor: 8.013
Authors: Mathijs L Tomassen; Jacquelien Pomp; Janneke van der Stap; Anne S R van Lindert; Max Peters; José S A Belderbos; Dirk K M De Ruysscher; Steven H Lin; Joost J C Verhoeff; Peter S N van Rossum Journal: Clin Transl Radiat Oncol Date: 2022-02-17
Authors: Alyssa Y Li; Karolina Gaebe; Katarzyna J Jerzak; Parneet K Cheema; Arjun Sahgal; Sunit Das Journal: Front Oncol Date: 2022-03-07 Impact factor: 6.244