Risk of Perihippocampal Recurrence After Hippocampal Avoidance in Prophylactic Cranial Irradiation: A Literature Review

TL;DR

This review examines the risk of brain recurrence near the hippocampus when avoiding it during radiation therapy for small-cell lung cancer patients.

Contribution

The paper reviews literature to assess the safety and efficacy of hippocampal avoidance in cranial irradiation for SCLC patients.

Findings

Hippocampal avoidance in PCI reduces cognitive decline without affecting survival.

Some studies report increased perihippocampal recurrence risk in non-oligometastatic patients.

Results across studies remain inconsistent, highlighting the need for further clinical trials.

Abstract

A standard practice in the treatment of patients with small-cell lung cancer (SCLC) is prophylactic cranial irradiation (PCI) to reduce the chance of brain metastases. However, whole brain radiation therapy (WBRT) has been associated with concerns about neurocognitive decline. This has led to the development of WBRT techniques with the simultaneous avoidance of the hippocampus (HA). This article reviews the existing literature on the incidence of hippocampal failure after HA PCI in patients with SCLC. The effort to protect the hippocampus aims to reduce side effects at a cognitive level, but, as reported in various studies, the results regarding safety and effectiveness are ambiguous. Some indicate a higher risk of recurrence in the hippocampal and perihippocampal regions, particularly in non-oligometastatic patients. Despite any concerns, many trials have shown that HA in PCI significantly reduces cognitive decline without compromising overall survival or control of brain metastases. The mixed results noted between studies indicate the necessity of clinical trials to elucidate the benefits and risks of PCI with simultaneous hippocampal protection in patients suffering from SCLC.

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