A low percentage of metastases in deep brain and temporal lobe structures
Autor: | Patrick Y. Wen, Ted K. Yanagihara, Nicholas J Giacalone, Hani Ashamalla, Kristin T Hsieh, Daniel Yang, Mark E. Hwang, Raymond Y. Huang, Albert W Lee, Anurag Saraf, Ayal A. Aizer, Tony J. C. Wang, J Ricardo McFaline-Figueroa, Cheng-Chia Wu, Vikram S. Soni |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Temporal lobe Cohort Studies 03 medical and health sciences 0302 clinical medicine Region of interest Neoplasms medicine Humans Hippocampus (mythology) Aged Aged 80 and over Brain Neoplasms business.industry Radiotherapy Planning Computer-Assisted Brain atlas Brain Radiotherapy Dosage Middle Aged Prognosis Temporal Lobe Radiation therapy Oncology Case-Control Studies 030220 oncology & carcinogenesis Basic and Translational Investigations Cohort Female Neurology (clinical) Brainstem Radiology Cranial Irradiation business Neurocognitive 030217 neurology & neurosurgery Follow-Up Studies |
Zdroj: | Neuro Oncol |
ISSN: | 1523-5866 1522-8517 |
Popis: | BACKGROUND: Whole-brain radiotherapy (WBRT) in patients with brain metastases (BM) is associated with neurocognitive decline. Given its crucial role in learning and memory, efforts to mitigate this toxicity have mostly focused on sparing radiation to the hippocampus. We hypothesized that BM are not evenly distributed across the brain and that several additional areas may be avoided in WBRT based on a low risk of developing BM. METHODS: We contoured 2757 lesions in a large, single-institution database of patients with newly diagnosed BM. BM centroids were mapped onto a standard brain atlas of 55 anatomic subunits and the observed percentage of BM was compared with what would be expected based on that region’s volume. A region of interest (ROI) analysis was performed in a validation cohort of patients from 2 independent institutions using equivalence and one-sample hypothesis tests. RESULTS: The brainstem and bilateral thalami, hippocampi, parahippocampal gyri, amygdala, and temporal poles had a cumulative risk of harboring a BM centroid of 4.83% in the initial cohort. This ROI was tested in 157 patients from the validation cohort and was found to have a 4.1% risk of developing BM, which was statistically equivalent between the 2 groups (P < 1 × 10(–6), upper bound). CONCLUSION: Several critical brain structures are at a low risk of developing BM. A risk-adapted approach to WBRT is worthy of further investigation and may mitigate the toxicities of conventional radiation. |
Databáze: | OpenAIRE |
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