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Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI

Michiel B. de Ruiter, Paul F. C. Groot, Sabine Deprez, Pim Pullens (UGent) , Stefan Sunaert, Dirk de Ruysscher, Sanne B. Schagen and José Belderbos
(2023) NEURO-ONCOLOGY. 25(1). p.167-176
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Abstract
Background Reducing radiation dose to the hippocampus with hippocampal avoidance prophylactic cranial irradiation (HA-PCI) is proposed to prevent cognitive decline. It has, however, not been investigated whether hippocampal atrophy is actually mitigated by this approach. Here, we determined whether HA-PCI reduces hippocampal atrophy. Additionally, we evaluated neurotoxicity of (HA-)PCI to other brain regions. Finally, we evaluated associations of hippocampal atrophy and brain neurotoxicity with memory decline. Methods High-quality research MRI scans were acquired in the multicenter, randomized phase 3 trial NCT01780675. Hippocampal atrophy was evaluated for 4 months (57 HA-PCI patients and 46 PCI patients) and 12 months (28 HA-PCI patients and 27 PCI patients) after (HA-)PCI. We additionally studied multimodal indices of brain injury. Memory was assessed with the Hopkins Verbal Learning Test-Revised (HVLT-R). Results HA-PCI reduced hippocampal atrophy at 4 months (1.8% for HA-PCI and 3.0% for PCI) and at 12 months (3.0% for HA-PCI and 5.8% for PCI). Both HA-PCI and PCI were associated with considerable reductions in gray matter and normal-appearing white matter, increases in white matter hyperintensities, and brain aging. There were no significant associations between hippocampal atrophy and memory. Conclusions HA-PCI reduces hippocampal atrophy at 4 and 12 months compared to regular PCI. Both types of radiotherapy are associated with considerable brain injury. We did not find evidence for excessive brain injury after HA-PCI relative to PCI. Hippocampal atrophy was not associated with memory decline in this population as measured with HVLT-R. The usefulness of HA-PCI is still subject to debate.
Keywords
Cancer Research, Neurology (clinical), Oncology, brain aging, brain injury, hippocampal atrophy, hippocampal avoidance, prophylactic cranial irradiation, memory, WHOLE-BRAIN RADIOTHERAPY, RANDOMIZED-TRIAL, WHITE-MATTER, RADIATION, VOLUME, MEMANTINE, SCLC, NETWORK, MEMORY

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Citation

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MLA
de Ruiter, Michiel B., et al. “Hippocampal Avoidance Prophylactic Cranial Irradiation (HA-PCI) for Small Cell Lung Cancer Reduces Hippocampal Atrophy Compared to Conventional PCI.” NEURO-ONCOLOGY, vol. 25, no. 1, 2023, pp. 167–76, doi:10.1093/neuonc/noac148.
APA
de Ruiter, M. B., Groot, P. F. C., Deprez, S., Pullens, P., Sunaert, S., de Ruysscher, D., … Belderbos, J. (2023). Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI. NEURO-ONCOLOGY, 25(1), 167–176. https://doi.org/10.1093/neuonc/noac148
Chicago author-date
Ruiter, Michiel B. de, Paul F. C. Groot, Sabine Deprez, Pim Pullens, Stefan Sunaert, Dirk de Ruysscher, Sanne B. Schagen, and José Belderbos. 2023. “Hippocampal Avoidance Prophylactic Cranial Irradiation (HA-PCI) for Small Cell Lung Cancer Reduces Hippocampal Atrophy Compared to Conventional PCI.” NEURO-ONCOLOGY 25 (1): 167–76. https://doi.org/10.1093/neuonc/noac148.
Chicago author-date (all authors)
de Ruiter, Michiel B., Paul F. C. Groot, Sabine Deprez, Pim Pullens, Stefan Sunaert, Dirk de Ruysscher, Sanne B. Schagen, and José Belderbos. 2023. “Hippocampal Avoidance Prophylactic Cranial Irradiation (HA-PCI) for Small Cell Lung Cancer Reduces Hippocampal Atrophy Compared to Conventional PCI.” NEURO-ONCOLOGY 25 (1): 167–176. doi:10.1093/neuonc/noac148.
Vancouver
1.
de Ruiter MB, Groot PFC, Deprez S, Pullens P, Sunaert S, de Ruysscher D, et al. Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI. NEURO-ONCOLOGY. 2023;25(1):167–76.
IEEE
[1]
M. B. de Ruiter et al., “Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI,” NEURO-ONCOLOGY, vol. 25, no. 1, pp. 167–176, 2023.
@article{01GK495KRQTKCFBKG2RWER9XQ9,
  abstract     = {{Background Reducing radiation dose to the hippocampus with hippocampal avoidance prophylactic cranial irradiation (HA-PCI) is proposed to prevent cognitive decline. It has, however, not been investigated whether hippocampal atrophy is actually mitigated by this approach. Here, we determined whether HA-PCI reduces hippocampal atrophy. Additionally, we evaluated neurotoxicity of (HA-)PCI to other brain regions. Finally, we evaluated associations of hippocampal atrophy and brain neurotoxicity with memory decline. Methods High-quality research MRI scans were acquired in the multicenter, randomized phase 3 trial NCT01780675. Hippocampal atrophy was evaluated for 4 months (57 HA-PCI patients and 46 PCI patients) and 12 months (28 HA-PCI patients and 27 PCI patients) after (HA-)PCI. We additionally studied multimodal indices of brain injury. Memory was assessed with the Hopkins Verbal Learning Test-Revised (HVLT-R). Results HA-PCI reduced hippocampal atrophy at 4 months (1.8% for HA-PCI and 3.0% for PCI) and at 12 months (3.0% for HA-PCI and 5.8% for PCI). Both HA-PCI and PCI were associated with considerable reductions in gray matter and normal-appearing white matter, increases in white matter hyperintensities, and brain aging. There were no significant associations between hippocampal atrophy and memory. Conclusions HA-PCI reduces hippocampal atrophy at 4 and 12 months compared to regular PCI. Both types of radiotherapy are associated with considerable brain injury. We did not find evidence for excessive brain injury after HA-PCI relative to PCI. Hippocampal atrophy was not associated with memory decline in this population as measured with HVLT-R. The usefulness of HA-PCI is still subject to debate.}},
  author       = {{de Ruiter, Michiel B. and Groot, Paul F. C. and Deprez, Sabine and Pullens, Pim and Sunaert, Stefan and de Ruysscher, Dirk and Schagen, Sanne B. and Belderbos, José}},
  issn         = {{1522-8517}},
  journal      = {{NEURO-ONCOLOGY}},
  keywords     = {{Cancer Research,Neurology (clinical),Oncology,brain aging,brain injury,hippocampal atrophy,hippocampal avoidance,prophylactic cranial irradiation,memory,WHOLE-BRAIN RADIOTHERAPY,RANDOMIZED-TRIAL,WHITE-MATTER,RADIATION,VOLUME,MEMANTINE,SCLC,NETWORK,MEMORY}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{167--176}},
  title        = {{Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI}},
  url          = {{http://doi.org/10.1093/neuonc/noac148}},
  volume       = {{25}},
  year         = {{2023}},
}
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