Cargando…
Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy
BACKGROUND: Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662000/ https://www.ncbi.nlm.nih.gov/pubmed/26611656 http://dx.doi.org/10.1186/s13014-015-0555-9 |
_version_ | 1782403094268608512 |
---|---|
author | Mahadevan, Anand Sampson, Carrie LaRosa, Salvatore Floyd, Scott R. Wong, Eric T. Uhlmann, Erik J. Sengupta, Soma Kasper, Ekkehard M. |
author_facet | Mahadevan, Anand Sampson, Carrie LaRosa, Salvatore Floyd, Scott R. Wong, Eric T. Uhlmann, Erik J. Sengupta, Soma Kasper, Ekkehard M. |
author_sort | Mahadevan, Anand |
collection | PubMed |
description | BACKGROUND: Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia. METHODS: Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means. RESULTS: All six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V(24) (9 cc vs. 44 cc, p < 0.0000) and V(30) (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area. CONCLUSIONS: HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia. |
format | Online Article Text |
id | pubmed-4662000 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-46620002015-11-28 Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy Mahadevan, Anand Sampson, Carrie LaRosa, Salvatore Floyd, Scott R. Wong, Eric T. Uhlmann, Erik J. Sengupta, Soma Kasper, Ekkehard M. Radiat Oncol Research BACKGROUND: Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia. METHODS: Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means. RESULTS: All six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V(24) (9 cc vs. 44 cc, p < 0.0000) and V(30) (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area. CONCLUSIONS: HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia. BioMed Central 2015-11-26 /pmc/articles/PMC4662000/ /pubmed/26611656 http://dx.doi.org/10.1186/s13014-015-0555-9 Text en © Mahadevan et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Mahadevan, Anand Sampson, Carrie LaRosa, Salvatore Floyd, Scott R. Wong, Eric T. Uhlmann, Erik J. Sengupta, Soma Kasper, Ekkehard M. Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
title | Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
title_full | Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
title_fullStr | Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
title_full_unstemmed | Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
title_short | Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
title_sort | dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662000/ https://www.ncbi.nlm.nih.gov/pubmed/26611656 http://dx.doi.org/10.1186/s13014-015-0555-9 |
work_keys_str_mv | AT mahadevananand dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT sampsoncarrie dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT larosasalvatore dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT floydscottr dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT wongerict dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT uhlmannerikj dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT senguptasoma dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy AT kasperekkehardm dosimetricanalysisofthealopeciapreventingeffectofhippocampussparingwholebrainradiationtherapy |