Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy.

Mahadevan, Anand

Sampson, Carrie

LaRosa, Salvatore

Floyd, Scott R

Wong, Eric T

Uhlmann, Erik J

Sengupta, Soma

Kasper, Ekkehard M

England

2018-01-01T18:20:18Z

2018-01-01T18:20:18Z

2015-11-26

BACKGROUND: Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia. METHODS: Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means. RESULTS: All six patients had fully preserved scalp hair and remained clinically cognitively intact 1-3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V24 (9 cc vs. 44 cc, p < 0.0000) and V30 (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area. CONCLUSIONS: HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia.

https://www.ncbi.nlm.nih.gov/pubmed/26611656

10.1186/s13014-015-0555-9

1748-717X

https://hdl.handle.net/10161/15934

eng

Springer Science and Business Media LLC

Radiat Oncol

10.1186/s13014-015-0555-9

Alopecia

Brain Neoplasms

Cranial Irradiation

Hippocampus

Humans

Radiation Injuries

Radiometry

Radiotherapy Dosage

Radiotherapy, Intensity-Modulated

Retrospective Studies

Scalp

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy.

Journal article

https://www.ncbi.nlm.nih.gov/pubmed/26611656

245

Basic Science Departments

Clinical Science Departments

Duke

Duke Cancer Institute

Institutes and Centers

Pharmacology & Cancer Biology

Radiation Oncology

School of Medicine

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Published online

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