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Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance.
- Source :
-
Radiation oncology (London, England) [Radiat Oncol] 2018 Jul 20; Vol. 13 (1), pp. 132. Date of Electronic Publication: 2018 Jul 20. - Publication Year :
- 2018
-
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.<br />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.<br />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.<br />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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1748-717X
- Volume :
- 13
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Radiation oncology (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 30029684
- Full Text :
- https://doi.org/10.1186/s13014-018-1077-z