Phase III Trial of Prophylactic Cranial Irradiation with or without Hippocampal Avoidance for SMALL-CELL LUNG Cancer
De Dios, N. R.; Murcia, M.; Counago, F.; Lopez, J.; Oses, M. R.; Ots, P. M. S.; Vallejo, C.; Tirado, F. J. L.; Garayo, I. T.; Garcia, C. C.; Sotoca, A.; Gispert, J. D.; Farre, N.; Manero, R. M.; Font, J. C.; De La Pena, M. J.; Jorda, X. D.; Gonzalez, C. O.; Trueba, T. R.; Blanco Ulla, Miguel; Bacaicoa, M. C.; Torrente, M.; Montero, M.; Torres, A. A.; Vera, J. E.; San Millan, J. M.; Calvo Crespo, Patricia
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Identificadores![](/xmlui/themes/Mirage2//images/despl_identif.png)
Identificadores
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Fecha de publicación
2019Título de revista
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Tipo de contenido
Publicación de congreso
Resumen
Purpose/Objective(s)
Clinical evidence suggests that radiation dose received by the hippocampus during whole brain radiotherapy may play a role in radiation-induced neurocognitive decline. To prospectively evaluate the neurocognitive (NC) benefit of hippocampal sparing (PCI-HA), we have developed a phase III clinical trial (PREMER) to test hippocampal sparing during PCI.
Materials/Methods
118 patients undergoing PCI were randomized to receive PCI (n=60) or PCI-HA (n=58). The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Linear accelerator –based intensity-modulated radiotherapy and Volumetric Modulated Arc Therapy treatment plans were generated for a prescription dose of 25 Gy in 10 fractions. The main objective was NC function at 3 months assessed by Free and Cued Selective Reminding Test (FCSRT). The FCSRT is a well-validated and reliable assessment of memory, including encoding, retrieval, and retention of new information over time.
Results
These treatment modalities spared the hippocampus, with a D100 of 8.4 ± 2.0 Gy and a maximum dose of 14.5 ± 3.3 Gy. There was a decline in free delayed recall in PCI vs PCI-HA arm at 3 months (21.7 vs 5.1%; p 0.01; OR 5 [IC 95% 1.36-18.87]) at 6 months (32.6 vs 7.3%; p 0.008; OR 6.1 [IC 95% 1.60-23.29]) and at 12 months (18.5 vs 3.8%; p 0.09; OR 5.7 [IC 95% 0.61-52.42])
Conclusion
There was a significant decline in memory in PCI group. Further investigation to assess its impact on long-term follow-up is in progress.
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