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Maybe this has been asked, but does anyone contour the contralateral hippocampus and put a constraint on it? Seems like something fun to try.
Cool, thanks. Those were, more or less, the constraints I was gonna go with, D100 < 9 Gy and dmax 16 as per HA-WBRT. thanks for the links.@Ray D. Ayshun - great question! I'm interested in learning what others with more experience do, but can share my thought process thus far:
I tend to contour C/L hippocampus and aim for ALARA, w/o sacrificing coverage as @evilbooyaa said
Old Mednet post I read few years ago by Vinai Gondi & Minesh Mehta mentioned hippocampus D100% ≤ 10 Gy and Maximum dose ≤ 17 Gy
Some interesting papers I've read related to this topic
1. Pretty good viewpoint on this subject: Hippocampal Avoidance for Gliomas
2. Less Hippocampus Atrophy with <10 Gy mean dose: Radiation dose-dependent hippocampal atrophy detected with longitudinal volumetric MRI
3. Primary brain tumor EQD2 to 40% of B/L hippocampi >7.3 Gy related to neurocognitive impairment: Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors - PubMed
4. RT dose & effect by brain substructure: https://www.thegreenjournal.com/article/S0167-8140(20)30154-7/abstract
I haven't heard that but it makes sense. I'd imaging the same thing is true for other brain substructures, or for other malignancies/organ subsites with disease outside of the primary). Breast is one example.Interesting question
Several years ago I think there was discussion of glioma tumor stem cells potentially residing in hippocampus. Anyone know more?
Interesting question
Several years ago I think there was discussion of glioma tumor stem cells potentially residing in hippocampus. Anyone know more?
Gbm is Palliative? I guess that's not a totally unreasonable perspective...I would only send these patients to a high volume palliative fellowship trained rad onc.
Oh I send all my patients only to a high volume palliative fellowship trained rad onc.Gbm is Palliative? I guess that's not a totally unreasonable perspective...
I definitely get it. But it's tough to be strident about what brain parts are or aren't important in humans.Well nobody's doing trials to determine how irradiating extremities in sts affects cognition. Anatomically, the brain seems important for cognition. Seems reasonable to think there's a most important part of the brain when it comes to that. I'm voting against the motor strip.
I definitely get it. But it's tough to be strident about what brain parts are or aren't important in humans.
@Ray D. Ayshun - great question! I'm interested in learning what others with more experience do, but can share my thought process thus far:
I tend to contour C/L hippocampus and aim for ALARA, w/o sacrificing coverage as @evilbooyaa said
Old Mednet post I read few years ago by Vinai Gondi & Minesh Mehta mentioned hippocampus D100% ≤ 10 Gy and Maximum dose ≤ 17 Gy
Some interesting papers I've read related to this topic
1. Pretty good viewpoint on this subject: Hippocampal Avoidance for Gliomas
2. Less Hippocampus Atrophy with <10 Gy mean dose: Radiation dose-dependent hippocampal atrophy detected with longitudinal volumetric MRI
3. Primary brain tumor EQD2 to 40% of B/L hippocampi >7.3 Gy related to neurocognitive impairment: Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors - PubMed
4. RT dose & effect by brain substructure: https://www.thegreenjournal.com/article/S0167-8140(20)30154-7/abstract
Ew. Protons for GBM is like one step away from protons for palliation. C'mon man!Now is contralateral sparing a good justification for protons in primary GBM? I know some docs who would argue this to be the case! Some patients eat it up too--there's this belief out there that protons must be better for everything since they're more expensive and limited to a smaller number of institutions.
2 steps away from G6 prostate ca, but whatever pays the bills....Ew. Protons for GBM is like one step away from protons for palliation. C'mon man!
Wouldn’t you want the very best most beautiful plan? Don’t lieEw. Protons for GBM is like one step away from protons for palliation. C'mon man!
Need to reduce “low dose bath” in case got to come in from the front for a lung met, leaves more roomProton CSI for leptomeningeal metastases is already being done, and that is purely palliative.
I've been doing this more often with my definitive CNS cases. There is no hard constraint that I am aware of at this time.Maybe this has been asked, but does anyone contour the contralateral hippocampus and put a constraint on it? Seems like something fun to try.