Estimated risk of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy: safety profile for RTOG 0933.
Estimated risk of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy: safety profile for RTOG 0933.
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DOI：
10.1016/j.radonc.2010.02.030
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Mehta MP
中科院分区：
文献类型：
--
作者：
Gondi V;Tome WA;Marsh J;Struck A;Ghia A;Turian JV;Bentzen SM;Kuo JS;Khuntia D;Mehta MP
RTOG 0933是一项在全脑放疗（HA-WBRT）期间海马回避的II期临床试验，以预防辐射诱导的神经认知下降。通过量化海马周围或海马转移的基线发生率，我们试图估计海马回避区（海马加5 mm边缘）发生转移的风险。对在两家独立机构接受治疗的≤10例脑转移瘤患者进行了审查。根据已发表的方案，使用治疗前、对比后MRI的轴向图像来勾画每个转移灶和海马的轮廓。使用二元逻辑回归分析，临床和影像学变量与海马周围转移相关，双侧p < 0.05具有统计学意义。在371例患者中确定了1133个转移灶。在8.6%的患者（95% CI 5.7-11.5%）和3.0%的脑转移瘤中观察到海马5 mm内的转移瘤。没有一个转移位于海马体内。颅内转移性疾病的总体积增加1 cm 3与海马周围转移存在的比值比为1.02（95% CI 1.006-1.034，p = 0.003）相关。由于海马周围转移风险估计为8.6%，我们认为HA-WBRT作为RTOG 0933的一部分，可安全用于脑转移患者的临床试验。
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 metastases, we sought to estimate the risk of developing metastases in the hippocampal avoidance region (the hippocampus plus 5mm margin). 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. 1133 metastases were identified in 371 patients. Metastases within 5mm 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 intracranial 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. 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.
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