Purpose:Hippocampal sparing whole-brain radiotherapy (HS-WBRT) showed significantly lower long-term side effects compared to standard WBRT. Aim of this study is to describe a HS-WBRT real-world monoinstitutional experience within a retrospective cohort.Methods:Patients who completed HS-WBRT course, with Karnofsky Performance Status ⩾ 60 and radiological diagnosis of brain metastases (BMs) were enrolled. Treatment was performed using helical Tomotherapy scheduled in 30 Gy in 10 or 12 fractions or 25 Gy in 10 fractions. Oncological outcomes were clinically and radiologically assessed every three months. Toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events 4.3.Results:One hundred and nineteen patients from 2016 to 2020 met inclusion criteria; after a median follow-up of 18 months, 29 patients were alive; 6- and 12-months overall survival rates were 66% and 41%, respectively. HS-WBRT response was assessed for 72 patients. Median time to any progression and intracranial failure (IF) was 4.5 and 13.7 months, respectively. The 6- and 12-month IF rates were 85% and 57%. Among 40 patients (34%) who experienced IF, 17 (42%) were oligometastatic, 23 (58%) polymetastatic and 15/40 developed IF within the hippocampi avoidance zone. No grade (G) ⩾ 2 acute toxicities were reported and one G2 (dizziness) late toxicity was described.Conclusions:HS-WBRT is well tolerated, and despite the hippocampal sparing region, the oncological control is satisfying. Further investigation is warranted to find patients who could most benefit from a HS-WBRT approach.

中文翻译：

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脑转移瘤全脑放疗中的海马区回避：对于所有人还是对于某些人？真实世界的可行性报告

目的：与标准 WBRT 相比，保留海马的全脑放疗 (HS-WBRT) 的长期副作用显着降低。本研究的目的是描述回顾性队列中的 HS-WBRT 真实世界单一机构经验。方法：纳入完成 HS-WBRT 课程、卡诺夫斯基体能状态≥ 60 且放射学诊断为脑转移 (BM) 的患者。使用螺旋断层放疗进行治疗，计划剂量为 30 Gy，分 10 或 12 次，或 25 Gy，分 10 次。每三个月对肿瘤学结果进行临床和放射学评估。根据美国国家癌症研究所不良事件通用术语标准4.3对毒性进行分级。结果：2016年至2020年有119名患者符合纳入标准；中位随访 18 个月后，29 名患者存活；6 个月和 12 个月的总生存率分别为 66% 和 41%。对 72 名患者的 HS-WBRT 反应进行了评估。任何进展和颅内衰竭 (IF) 的中位时间分别为 4.5 个月和 13.7 个月。6个月和12个月的IF率分别为85%和57%。在 40 名经历 IF 的患者 (34%) 中，17 名 (42%) 为寡转移，23 名 (58%) 为多转移，15/40 在海马回避区内发生 IF。未报告 (G)⩾ 2 级急性毒性，并描述了 1 例 G2（头晕）晚期毒性。结论：HS-WBRT 耐受性良好，尽管有海马保留区，但肿瘤控制令人满意。需要进一步调查来寻找最能从 HS-WBRT 方法中受益的患者。