Central Nervous System

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MO_3_2514 - Hippocampal sparing preserves neurocognitive functions in patients of Pituitary adenoma treated with IG-IMRT technique.

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Hippocampal sparing preserves neurocognitive functions in patients of Pituitary adenoma treated with IG-IMRT technique.
U. S. Gaikwad1, G. Sastri2, T. Gupta3, R. Jalali3, R. V2, R. Kinhikar3, J. Swamidas2, and S. Goswami2; 1TATA MEMORIAL CENTRE, MUMBAI, India, 2TATA MEMORIAL HOSPITAL, MUMBAI, India, 3Tata Memorial Centre, Mumbai, India

Purpose/Objective(s): Patients with pituitary adenoma who undergo radiotherapy survive long enough to develop neurocognitive and endocrine deficits, therefore it is important to reduce the long term complication profile in these patients .Both preclinical and clinical evidence suggests that hippocampus is an important organ in the brain which is associated with neurocognitive functions of the brain. This prospective study is an attempt to study the feasibility of preserving neurocognitive functions in these patients by limiting hippocampal radiotherapy doses using Intensity modulated radiotherapy techniques (IMRT).

Materials/Methods: Fifty patients of pituitary adenoma received high precision radiotherapy by IMRT technique to a dose of 45Gy in 25 fractions over 5 weeks. All patients underwent baseline neuropsychological and QOL assessment at baseline(pre – RT) then subsequently at 6,12,18, 24, 36, 48, 60 months. Hippocampal doses were kept as low as possible while planning. Hippocampal dose parameters assessed were D max, D mean, D min, V7 Gy (CC), V7 (%) V 28 Gy (cc), V 28 Gy (%). Change in intelligence quotient (IQ) scores and QOL scores between baseline and at 18 months were documented.

Results: With IMRT technique we were able to achieve following dose constraints to the hippocampi, D- Max (Maximum dose received by hippocampus) 34.35 Gy (Right) 31.34 Gy (Left), D- Mean (Mean dose received by hippocampus) 10.4 Gy (Right), 9.45 Gy (Left), D Min (Minimum dose received by hippocampus) 1.38 Gy (Right) 1.25 Gy (Left). V7 (Hippocampal Volume receiving 7 Gy) 0.68 cc (Right) 0.80 cc (Left), V7 % (Percentage hippocampal volume receiving 7 Gy) 50.86 % (right) 58.40 % (Left), V28 (Volume receiving 28 Gy) 0.27 cc (Right) and 0.073 cc (Left). When compared baseline neurocognition scores (WAIS and DST scores) to scores at 18 months post radiotherapy did not show any statistically significant decline (p value > 0.05). Quality of life scores (Various domains such as physical, social, role functioning, cognitive, emotional and global) at baseline and at 18 months did not show any decline. (p value > 0.05)

Conclusion: It is feasible to reduce mean hippocampal doses using IMRT technique in routine clinical practice. Sparing hippocampi in adult pituitary adenoma patients preserves long term neurocognitive functions and quality of life.

Author Disclosure: U.S. Gaikwad: None. G. Sastri: None. T. Gupta: None. R. V: None. R. Kinhikar: None. S. Goswami: None.

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