Hippocampal-Sparing Radiation Therapy in Primary Sinonasal and Cutaneous Tumors of the Head and Neck

被引:0
|
作者
Hall, Jacob [1 ]
Dance, Michael [1 ]
Huang, Benjamin [2 ]
Steele, Ethan [1 ]
Nguyen, Lorie [3 ]
Repka, Michael [1 ]
Chen, Xuguang [1 ]
Shen, Colette [1 ]
机构
[1] Univ N Carolina, Dept Radiat Oncol, Chapel Hill, NC 27514 USA
[2] Univ N Carolina, Dept Radiol, Chapel Hill, NC USA
[3] Univ N Carolina, Chapel Hill, NC USA
关键词
COGNITIVE DYSFUNCTION; RADIOTHERAPY; BRAIN; DOSIMETRY; MEMORY;
D O I
10.1016/j.adro.2024.101588
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Patients with primary sinonasal and cutaneous head and neck (H&N) malignancies often receive meaningful radiation dose to their hippocampi, but this not a classic avoidance structure in radiation planning. We aimed to characterize the feasibility and tradeoffs of hippocampal-sparing radiation therapy (HSRT) for patients with primary sinonasal and cutaneous H&N malignancies. Methods and Materials: We retrospectively selected patients who were treated definitively fi nitively for primary sinonasal or cutaneous malignancies of the H&N at an academic medical center. All received (chemo)radiation alone or adjuvantly and substantial radiation dose to 1 or both hippocampi. We created new HSRT plans for each patient with intensity modulated radiation therapy using the original target and organ-at-risk (OAR) volumes. Hippocampi were contoured based on Radiation Therapy Oncology Group guidelines and reviewed by a neuroradiologist. Absolute and relative differences in radiation dose to the hippocampi, planning target volumes (PTVs), and OARs were recorded and compared. Results: There were 18 sinonasal and 12 cutaneous H&N primary tumors (30 patients in total). Median prescription dose was 6600 cGy (range, 5000-7440 cGy), and 14 of the 30 patients received 120 cGy/fraction twice daily, 13 of the 30 patients received 200 cGy/fraction once daily, whereas others received 180-275 cGy/fraction once daily. The relative decrease in ipsilateral hippocampal D max and D100% using HSRT was 44% (median, 2009 cGy from 3586 cGy) and 65% (median 434 cGy from 1257 cGy), respectively. There were no statistically significant fi cant or clinically meaningful differences in PTV V100%, PTV D1%, or radiation dose to other OARs between HSRT and non-HSRT plans. Conclusions: HSRT is feasible and results in meaningful dose reduction to the hippocampi without reducing PTV coverage or increasing dose to other OARs. We suggest target hippocampal constraints of D-max < 1600 cGy and D100% < 500 cGy when feasible (without compromising PTV coverage or impacting other critical OARs). The clinical significance fi cance of HSRT in patients with primary H&N tumors should be investigated prospectively. (c) 2024 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.
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页数:7
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