| Background and ObjectivesBrain metastases(BM)are the most common brain tumors in adult,the incidence is close to 10/100000.The accurate incidence of BM may be higher than the data reported in the literatures,and the number is growing rapidly.BM suggested that the prognosis of malignant tumor patients was poor,and the symptoms,including headache,dizziness,nausea,vomiting,fatigue and so on,seriously reduce the quality of life of patients.Whole-brain radiotherapy(WBRT)is one of the standard treatments of BM,and its clinical application is still developing rapidly.Neurocognitive function(NCF)injury caused by WBRT gradually attracted clinical attention.The decrease of NCF was related to the injury of hippocampal(HP)after radiotherapy.Hippocampal-sparing whole-brain radiotherapy(HS-WBRT)protects HP and avoids NCF disorders.The development of tomotherapy(TOMO)makes HS-WBRT possible to avoid NCF damage in patients with BM after radiotherapy.In this study,patients with BM were divided into two groups: WBRT group,with,without hippocampus-sparing;HS-WBRT group with TOMO,with hippocampus-sparing.Statistical analysis of the parameters of the two groups and the NCF scores after radiotherapy were used to explore the feasibility of hippocampus-sparing in whole-brain radiotherapy and the relationship between hippocampussparing and NCF injury after radiotherapy.MethodsA total of 43 patients with BM were enrolled in this study from August 2015 to August 2016 in Zhengzhou First Affiliated Hospital,22 patients were treated with WBRT,and the other 21 patients were treated with HS-WBRT.Statistics on parameters and NCF scores of the two groups with SPSS 21.0 software.Dosimetric and NCF scores’ s comparison between the two groups: the Shapiro-Wilk test was used to test the normality of the two sets of datas.The Levene test was used to test the homogeneous:firstly,datas of the two groups were the normal distribution,and in accordance with the homogeneity of variance,t test was used;secondly,datas of two groups were not subject to normal distribution with heterogeneity of variance,adjusted-t test was used;datas did not subject to normal distribution,using the Wilcoxon rank sum test.The NCF scores’ s comparison of before and after treatmean: datas were the normal distribution,and in accordance with the homogeneity of variance,paired t test was used;otherwise Wilcoxon rank sum test was used.Test criteria: P < 0.05 was considered statistically significant.ResultsThe plan target volume(PTV)comparison between the two groups was not statistically significant(P>0.05).The comparison of HI was statistically significant(P<0.05),3D-CRT was significantly better than the TOMO in the target dose uniformity.The comparison of Dmean(left HP P=0.00;left HP P=0.00)and Dmax(left HP P=0.00;left HP P=0.00)were statistically significant.TOMO was significantly better than 3D-CRT in Dmean and Dmax of HP,left HP’s Dmean,Dmax dropped to 20.14%,35.39% of 3D-CRT,right HP’s Dmean,Dmax dropped to 19.92%,35.14% of 3D-CRT.There were was not statistically significant in NCF score of two groups before treatment,and 1 month after treatment(P>0.05).There were was statistically significant in NCF score of two groups 3 months after treatment,and 6 months after treatment(P<0.05).In TOMO group,the comparison between before treatment and after treatment was not statistically significant(P>0.05).In 3D-CRT group,the comparison between before treatment and and 1 month after treatment was not statistically significant(P>0.05);and the comparison between before treatment and 3 months after treatment,6 months after treatment was statistically significant(P<0.05).NCF score of TOMO group was better than that of 3D-CRT group.No grade 3 or more adverse reactions were observed.ConclusionBM treatment with HS-WBRT is feasible.TOMO can reduce the HP dose,which to avoid the damage of NCF to some extent;but TOMO has no advantage compared wifh 3D-CRT on HI. |
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