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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Hippocampal-sparing radiotherapy: The new standard of care for World Health Organization grade II and III gliomas?
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Hippocampal-sparing radiotherapy: The new standard of care for World Health Organization grade II and III gliomas?

机译：海马保留放射疗法：世界卫生组织II级和III级神经胶质瘤的新护理标准？

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摘要

The neurocognitive effects of cranial radiotherapy in patients with gliomas are well-recognised and may be related to the dose delivered to the hippocampi. Intensity modulated radiotherapy (IMRT) is a radiotherapy technique that can be used to selectively spare the hippocampi without compromising the dose delivered to the tumour. This study aimed to evaluate if hippocampal-sparing IMRT is achievable in patients with World Health Organization (WHO) grade II and III gliomas. A retrospective review of consecutive patients with WHO grade II and III gliomas treated with IMRT at our institution between January 2009 and August 2012 was performed. Hippocampal-sparing was defined as a mean dose to at least one hippocampus of less than 30 Gy. The dose delivered to the tumour was never compromised to achieve the hippocampal dose constraint. Logistic regression analyses were performed to identify predictive factors for achieving hippocampal-sparing treatment. Eighteen patients were identified and hippocampal-sparing was achieved in 14 (78%). The median dose prescribed was 59.4 Gy in 33 fractions and 11 patients had WHO grade III gliomas. The mean dose to the contralateral hippocampus was 24.9 Gy. Planning target volumes less than 420.5 cm3 were more likely to enable hippocampal-sparing treatment to be given (hazard ratio 1.7, p = 0.03) and there was a trend with oligodendrogliomas and anaplastic oligodendrogliomas. Hippocampal-sparing radiotherapy is feasible in patients with WHO grade II and III gliomas. Oncologic outcomes are yet to be assessed prospectively. The relationship between hippocampal dose and neurocognitive function in adults is currently under investigation.
机译：颅脑放疗对神经胶质瘤患者的神经认知作用已广为人知，并且可能与输送至海马体的剂量有关。调强放射疗法（IMRT）是一种放射疗法技术，可用于选择性地保留海马体而不损害传递给肿瘤的剂量。这项研究旨在评估在世界卫生组织（WHO）的II级和III级神经胶质瘤患者中能否实现保留海马的IMRT。我们对2009年1月至2012年8月间在我院接受IMRT治疗的世卫组织II级和III级神经胶质瘤连续患者进行了回顾性研究。海马保留定义为至少一个小于30 Gy的海马的平均剂量。从未损害传递到肿瘤的剂量以达到海马剂量限制。进行逻辑回归分析，以确定实现海马保护治疗的预测因素。确定了18例患者，其中14例（78％）实现了海马保护。规定的中位剂量为33个分数中的59.4 Gy，11名患者患有WHO III级神经胶质瘤。对侧海马的平均剂量为24.9 Gy。计划的目标体积小于420.5 cm3更有可能给予海马保留治疗（危险比1.7，p = 0.03），少突神经胶质瘤和间变性少突神经胶质瘤有发展趋势。对于具有WHO II级和III级神经胶质瘤的患者，保留海马放疗是可行的。肿瘤学结局尚待评估。成人海马剂量与神经认知功能之间的关系目前正在研究中。

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