Hippocampal sparing

[Kroll2013]

Dear colleagues, i have a 54yo patient known to have a locally advanced breast carcinoma. She presented for meningeal seeding, secondary skull bone involvement and positive LP.

Is HS-WBRT an option?

Ty

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[evilbooyaa]

In all the trials, leptomeningeal disease is a contraindication to HS-WBRT.

 

[Palex80]

Actually no.

1. Just like evilboyaa said, meningeal spread is a contraindication and it makes sense actually, since meningeal spread is disseminated disease.
2. Although she is a breast cancer patient (who tend to fare better than the rest) meningeal spread is usually linked to catastrophic prognosis. Even if you would do hippocampal sparing it is highly unlikely that she would live long enough to have an advantage due to less toxicity. The prognosis of most patients with meningeal spread is measured in weeks.