1. Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance.
- Author
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Martinage G, Hong AM, Fay M, Thachil T, Roos D, Williams N, Lo S, and Fogarty G
- Subjects
- Adult, Aged, Aged, 80 and over, Australia, Brain Neoplasms secondary, Cranial Irradiation standards, Dose Fractionation, Radiation, Female, Humans, Male, Melanoma secondary, Middle Aged, Organ Sparing Treatments standards, Organ Sparing Treatments statistics & numerical data, Radiosurgery methods, Radiosurgery standards, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Intensity-Modulated standards, Retrospective Studies, Young Adult, Brain Neoplasms radiotherapy, Cranial Irradiation methods, Hippocampus radiation effects, Melanoma radiotherapy, Organ Sparing Treatments methods, Quality Assurance, Health Care, Radiation Injuries prevention & control, Radiotherapy, Intensity-Modulated methods
- Abstract
Background: Melanoma brain metastases (MBM) often cause morbidity and mortality for stage IV melanoma patients. An ongoing randomised phase III trial (NCT01503827 - WBRT-Mel) evaluates the role of adjuvant whole brain radiotherapy (WBRT) following local treatment of MBM. Hippocampal avoidance during WBRT (HA-WBRT) has shown memory and neurocognitive function (NCF) preservation in the RTOG-0933 phase II study. This study assessed the quality assurance of HA-WBRT within the WBRT-Mel trial according to RTOG-0933 study criteria., Methods: Hippocampal avoidance was allowed in approved centres with intensity-modulated radiotherapy capability. Patients treated by HA-WBRT were not randomized within the WBRT arm. The RTOG 0933 contouring Atlas was used to contour hippocampi. In the trial co-ordinating centre, patients were treated with volumetric modulated arc therapy using complementary arcs; similar techniques were used at other sites. Dosimetric data were extracted retrospectively and analysed in accordance with RTOG 0933 study constraints criteria., Results: Among the 215 patients accrued to the WBRT-Mel study between April 2009 and September 2017, 107 were randomized to the WBRT arm, 22 were treated by HA-WBRT in 4 centers. Eighteen patients were treated in the same centre. The median age was 65 years. The commonest (91%) HA-WBRT schema was 30 Gy in 10 fractions. Prior to HA-WBRT, 10 patients had been treated by surgery alone, six by radiosurgery alone, four by surgery and radiosurgery and two exclusively by simultaneous integrated boost concurrent to HA-WBRT. Twenty patients were treated with intention to spare both hippocampi and two patients had MBM close to one hippocampus and were treated with intention to spare the contralateral hippocampus. According to RTOG-0933 study criteria, 18 patients (82%) were treated within constraints and four patients (18%) had unacceptable deviation in just one hippocampus., Conclusions: This dosimetric quality assurance study shows good compliance (82%) according to RTOG-0933 study dosimetric constraints. Indeed, all patients respected RTOG hippocampal avoidance constraints on at least one hippocampus. In the futureanalysis of the WBRT-Mel trial, the NCF of patients on the observation arm, WBRT arm and with HA-WBRT arm will be compared.
- Published
- 2018
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