Hippocampal Avoidance Prophylactic Cranial Irradiation: A New Standard of Care?
Mené sur 150 patients atteints d'un cancer du poumon à petites cellules (durée médiane de suivi : 40,4 mois), cet essai randomisé de phase III évalue l'intérêt, du point de vue de la préservation de la fonction cognitive, d'une irradiation crânienne prophylactique épargnant l'hippocampe
Given the high propensity for small-cell lung cancer (SCLC) to develop brain metastases, prophylactic cranial irradiation (PCI) is a standard for care for patients with limited-stage SCLC and a therapeutic option for those with extensive-stage SCLC. Although meta-analyses and a prospective randomized trial have shown a survival benefit with the use of PCI, both clinicians and patients are hesitant to pursue PCI because of concerns about cognitive toxicity after PCI. Preclinical and clinical studies have found cognitive toxicity to be associated with radiation dose exposure delivered to exquisitely radiosensitive neural stem cells located within the hippocampal dentate gyrus. In an effort to decrease these cognitive risks, hippocampal avoidance (HA) techniques have been developed using intensity-modulated radiotherapy to significantly lower radiation dose exposure to the hippocampal neural stem-cell compartment, while delivering tumoricidal radiation dose to the remainder of the brain (Figs 1A and 1B).
Journal of Clinical Oncology , éditorial en libre accès, 2020