Evaluating the impact of hippocampal sparing during whole brain radiotherapy on neurocognitive functions: A preliminary report of a prospective phase II study

Shinn Yn Lin, Chi Cheng Yang, Yi Ming Wu, Chen Kan Tseng, Kuo Chen Wei, Yi Chuan Chu, Hsiang Yao Hsieh, Tung Ho Wu, Ping Ching Pai, Peng Wei Hsu, Chi Cheng Chuang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

22 Scopus citations

Abstract

Background:Whole brain radiotherapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCFs) decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving WBRT. Methods: Twenty-five patients who were referred for prophylactic cranial irradiation (PCI) or treating oligometastatic brain disease were enrolled in the study. Before the HA-WBRT course, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed. The primary endpoint was delayed recall, as determined by the change/decline in verbal memory [Wechsler Memory Scale - 3 rd edition (WMS III)- Word List score] from the baseline assessment to 4 months after the start of HA-WBRT. Results: Only three patients belonged to the clinical setting of PCI; the remaining 22 patients had oligometastatic brain disease. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiotherapy intervals, in immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F = 5.727, p = 0.048). Conclusions: Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA-WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control.

Original languageEnglish
Pages (from-to)439-449
Number of pages11
JournalBiomedical Journal
Volume38
Issue number5
DOIs
StatePublished - 01 09 2015

Bibliographical note

Publisher Copyright:
© 2015 Biomedical Journal | Published by Wolters Kluwer - Medknow.

Keywords

  • brain metastasis
  • hippocampus
  • hippocampus avoidance during whole brain radiotherapy
  • neurocognitive function
  • whole brain radiotherapy

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