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Incidence of hippocampal and perihippocampal brain metastases and impact on hippocampal-avoiding radiotherapy: a systematic review and meta-analysis

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 hippocampa...

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Main Authors: Wiegreffe, Shari (Author) , Sarria, Gustavo Renato (Author) , Layer, Julian (Author) , Dejonckheere, Egon (Author) , Nour, Younèss (Author) , Schmeel, Carsten (Author) , Giordano, Frank Anton (Author) , Schmeel, Christopher (Author) , Popp, Ilinca (Author) , Grosu, Anca-Ligia (Author) , Gkika, Eleni (Author) , Stefaan Dejonckheere, Cas (Author)
Format: Article (Journal)
Language:English
Published: August 2024
In: Radiotherapy and oncology
Year: 2024, Volume: 197, Pages: 1-9
ISSN:1879-0887
DOI:10.1016/j.radonc.2024.110331
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.radonc.2024.110331
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0167814024006017
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Author Notes:Shari Wiegreffe, Gustavo Renato Sarria, Julian Philipp Layer, Egon Dejonckheere, Younèss Nour, Frederic Carsten Schmeel, Frank Anton Giordano, Leonard Christopher Schmeel, Ilinca Popp, Anca-Ligia Grosu, Eleni Gkika, Cas Stefaan Dejonckheere
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Summary: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.
Item Description:Online verfügbar: 19. Mai 2024, Artikelversion: 21. Mai 2024
Gesehen am 02.01.2025
Physical Description:Online Resource
ISSN:1879-0887
DOI:10.1016/j.radonc.2024.110331

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