title: Evaluating the impact of hippocampal sparing during whole brain radiotherapy on neurocognitive functions: A preliminary report of a prospective phase II study.
abstract: BACKGROUND
  Whole brain radiotherapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCFs) decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving WBRT.
  
  
  METHODS
  Twenty-five patients who were referred for prophylactic cranial irradiation (PCI) or treating oligometastatic brain disease were enrolled in the study. Before the HA-WBRT course, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed. The primary endpoint was delayed recall, as determined by the change/decline in verbal memory [Wechsler Memory Scale - 3rd edition (WMS III)- Word List score] from the baseline assessment to 4 months after the start of HA-WBRT.
  
  
  RESULTS
  Only three patients belonged to the clinical setting of PCI; the remaining 22 patients had oligometastatic brain disease. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiotherapy intervals, in immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F = 5.727, p = 0.048).
  
  
  CONCLUSIONS
  Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA-WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control.
authors.forename: Shinn-Yn
authors.initials: SY
authors.lastname: Lin
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Yang
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Wu
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wei
authors.forename: Yi-Chuan
authors.initials: YC
authors.lastname: Chu
authors.forename: Hsiang-Yao
authors.initials: HY
authors.lastname: Hsieh
authors.forename: Tung-Ho
authors.initials: TH
authors.lastname: Wu
authors.forename: Ping-Ching
authors.initials: PC
authors.lastname: Pai
authors.forename: Peng-Wei
authors.initials: PW
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D003071:Cognition / Q000187:drug effects*; D016371:Cranial Irradiation / Q000379:methods; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008568:Memory / Q000187:drug effects*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D016896:Treatment Outcome