INTRODUCTION: Hippocampi sparing whole brain radiotherapy (WBRT) is an evolving approach in the treatment of patients with multiple brain metastases, pursuing mitigation of verbal memory decline as a consequence of hippocampal radiation injury. Accumulating data are showing different postradiotherapy changes in the left and right hippocampus with a theoretical proposal of only unilateral (dominant, left) hippocampal sparing during WBRT. METHOD: The aim of this retrospective study is to describe spatial distribution of brain metastases on MRI in a cohort of 260 patients (2595 metastases) and to evaluate distribution separately in the left and right hippocampus and in respective hippocampal avoiding zones (HAZ, region with subtherapeutic radiation dose), including evaluation of location of metastatic mass centre. RESULTS: The median number of brain metastases was three, with lung cancer being the most common type of primary tumour; 36% had single metastasis. Almost 8% of patients had metastasis within hippocampus (1.1% of all metastases) and 18.1% of patients within HAZ (3.3% of all metastases). No statistically significant difference was observed in the laterality of hippocampal involvement, also when the location of centre of metastases was analyzed. There were more patients presenting the centre of metastasis within left (15) versus right (6) HAZ approaching the borderline of statistical significance. CONCLUSION: No significant difference in the laterality of BM seeding within hippocampal structures was observed. The hypothesized unilateral sparing WBRT would have theoretical advantage in about 50% reduction in the risk of subsequent recurrence within spared regions.

• MeSH
• Hippocampus diagnostic imaging   MeSH
• Organ Sparing Treatments * MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Metastasis MeSH
• Brain Neoplasms diagnostic imaging   pathology   radiotherapy   MeSH
• Retrospective Studies MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH

Esophageal cancer (EC) consists of tumors with a generally poor prognosis, and treatment options for patients with disease recurrence are extremely limited. Due to this poor patient prognosis, the possible treatment toxicity should be carefully balanced against its potential benefit and patient quality of life. Stereotactic body radiotherapy (SBRT) is a rapidly expanding novel technique combining a short treatment time together with high local efficacy and an acceptable toxicity profile. There are no publications thus far presenting data regarding the usage of SBRT utilizing a conventional linear accelerator in locally recurrent EC patients. In the present study, 2 patients with recurrent EC in the neck lymph nodes were treated by SBRT in the Department of Oncology, University Hospital Olomouc, Czech Republic. The treatment dose was 30 and 40 Gy in 5 daily fractions, with a prescribed dose to 65 and 81% isodose, for each patient respectively, utilizing a volumetric arc therapy technique, a 6-MV photon beam and an Elekta Synergy linear accelerator. The treatment was delivered without any unintentional treatment interruptions and without any treatment-related acute toxicity. The maximum dose in the patients was 45.9 and 49.2 Gy, respectively. The maximum doses for the surrounding major blood vessels were 35.4 and 45.7 Gy, respectively. Maximum doses to the trachea and the esophagus in the first patient were 32.6 and 27.0 Gy. In the second patient, these doses were not clinically significant. SBRT utilizing linear accelerators should be considered in patients with localized recurrent EC, offering the patients the chance for local control with minimal treatment toxicity.

• Keywords
• chemotherapy, esophageal cancer, recurrence, stereotactic radiotherapy,
• Publication type
• Journal Article MeSH