Lung Cancer

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TU_37_3689 - Hippocampal-Sparing Prophylactic Cranial Irradiation in Small Cell Lung Cancer: a phase II clinical trail

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Hippocampal-Sparing Prophylactic Cranial Irradiation in Small Cell Lung Cancer: a phase II clinical trail
X. Dong1, Z. Zhou1, X. Liu1, W. Wang1, Z. Xiao2, D. Chen2, T. Zhang3, X. Wang1, Q. Feng1, J. Liang1, N. Bi3, Y. R. Zhai1, Z. Hui1, X. Wang3, J. Lv3, L. Wang1, and Y. Li4; 1Department of Radiation Oncology, National Cancer Center / Cancer Institute & Hospital, Chinese Academic of Medical Sciences, Peking Union Medical College, Beijing, China, 2Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 3National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 4National Cancer Canter/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Purpose/Objective(s): To prospectively evaluate the effectiveness, toxicity and cognitive function of hippocampal-sparing prophylactic cranial irradiation(HS-PCI) in patients with small-cell lung cancer by using helical Tomotherapy(HT).

Materials/Methods: Between April 2014 and March 2017, 49 Patients with SCLC, achieving a complete response to chemoradiotherapy and no brain metastases, were eligible. The hippocampus was contoured, and hippocampal avoidance regions were created using a 3mm volumetric expansion around the hippocampus. Patients received PCI 25 Gy/10 fractions, with a mean hippocampal dose limited to <8 Gy. The toxicity, cranial metastasis, neurocognitive function of patients will be evaluated. The cognitive function measured by the Hopkins Verbal Learning Test-Revised and Mini-mental State Examination at 6 months and 12months after PCI.

Results: HT spared the hippocampus and expansion around the hippocampus with 7.23Gy and 8.46Gy. hippocampal dose was reduced to 71.88% and 66.16% to compare with Prescription doses. Hippocampal maximum dose was 10.66Gy. 8 patients were dead. 1-year and 2-year survival rate were 85.1% and 70.3%. 9 patients occurred brain metastases(18.3%). None >3 grade toxicity was observed. The toxicity was mainly headache, dizziness, hair loss reactions. No significant decline in MMSE(minimum-mental state examination) scores was observed(29.42,29.25,29.10score,p=0.337,0.212). After 1 year from treatment, the HVLT score was relatively decline 6.78% (19.90, 18.65, p=0.001) compared with pretreatment score. However, there were no significant decline of HVLT score in the patients without brain metastases(p=0.763).

Conclusion: This study suggests a potential benefit of hippocampal-sparing PCI in SCLC patients with rates of brain and hippocampal metastases consistent with standard PCI. Further research and long-term observation was required.

Author Disclosure: X. Dong: None. X. Liu: None. T. Zhang: None. N. Bi: None. L. Wang: professor; Cancer Hospital of Chinese Academy Medical Science. Y. Li: doctor; Cancer Hospital of Chinese Academy Medical Science.

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