Treating patients with brain metastases has evolved: scalp-sparing, hippocampal avoidance whole brain radiotherapy with simultaneous integrated boost

• Published in: BMJ case reports 2017-12, Vol.2017, p.bcr-2017-223449
• Main Authors: Ahmad, Irfan, Chufal, Kundan Singh, Bhatt, Chandi Prasad, Rathour, Sandeep
• Format: Article
• Language: English
• Subjects: Adult; Baldness; Brain cancer; Brain Neoplasms - pathology; Brain Neoplasms - radiotherapy; Brain Neoplasms - secondary; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Case reports; Cranial Irradiation - methods; Hippocampus; Humans; Images In; Lung cancer; Male; Metastasis; Organ Sparing Treatments; Patient Satisfaction; Patients; Planning; Radiation therapy; Radiotherapy Planning, Computer-Assisted; Scalp; Surgery; Treatment Outcome
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-223449

The patient developed transient alopecia 2 weeks post-treatment with full recovery at 2month follow-up ( figure 3 ), and neurocognitive function (assessed by Hopkins Verbal Learning Tool-Revised) also remained stable on follow-up compared with pretreatment levels. The standard management of a patient with solitary brain metastasis is either upfront surgery, stereotactic radiosurgery (SRS), WBRT or a combination of these modalities. 1 While surgery is considered the standard of care, the rate of inhospital mortality is 2.3%, and 17% are discharged to long-term care facilities or rehabilitation centres. 1 In recent years, there is an increased recognition of the deleterious effects of WBRT on neurocognition, especially memory, which is not represented in the Mini-Mental Status Examination score. The key determinant of memory dysfunction after radiotherapy to the brain is the dose received by the hippocampus, a reservoir of neural stem cells responsible for the formation of new memories. 2 SRS is considered a viable alternative to surgery with excellent local control and has better neurocognitive outcomes compared with WBRT, at the cost of higher rate of intracranial disease progression, which requires retreatment, usually with SRS. 1 Results from a recent trial suggest that sparing the hippocampus preserves neurocognitive function and quality of life in patients undergoing radiotherapy for brain metastases. 2 Another trial recently demonstrated that WBRT with a higher delivered dose to the metastasis is feasible with an overall response rate of 78%.