PMID- 30029684 OWN - NLM STAT- MEDLINE DCOM- 20190128 LR - 20240328 IS - 1748-717X (Electronic) IS - 1748-717X (Linking) VI - 13 IP - 1 DP - 2018 Jul 20 TI - Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance. PG - 132 LID - 10.1186/s13014-018-1077-z [doi] LID - 132 AB - BACKGROUND: Melanoma brain metastases (MBM) often cause morbidity and mortality for stage IV melanoma patients. An ongoing randomised phase III trial (NCT01503827 - WBRT-Mel) evaluates the role of adjuvant whole brain radiotherapy (WBRT) following local treatment of MBM. Hippocampal avoidance during WBRT (HA-WBRT) has shown memory and neurocognitive function (NCF) preservation in the RTOG-0933 phase II study. This study assessed the quality assurance of HA-WBRT within the WBRT-Mel trial according to RTOG-0933 study criteria. METHODS: Hippocampal avoidance was allowed in approved centres with intensity-modulated radiotherapy capability. Patients treated by HA-WBRT were not randomized within the WBRT arm. The RTOG 0933 contouring Atlas was used to contour hippocampi. In the trial co-ordinating centre, patients were treated with volumetric modulated arc therapy using complementary arcs; similar techniques were used at other sites. Dosimetric data were extracted retrospectively and analysed in accordance with RTOG 0933 study constraints criteria. RESULTS: Among the 215 patients accrued to the WBRT-Mel study between April 2009 and September 2017, 107 were randomized to the WBRT arm, 22 were treated by HA-WBRT in 4 centers. Eighteen patients were treated in the same centre. The median age was 65 years. The commonest (91%) HA-WBRT schema was 30 Gy in 10 fractions. Prior to HA-WBRT, 10 patients had been treated by surgery alone, six by radiosurgery alone, four by surgery and radiosurgery and two exclusively by simultaneous integrated boost concurrent to HA-WBRT. Twenty patients were treated with intention to spare both hippocampi and two patients had MBM close to one hippocampus and were treated with intention to spare the contralateral hippocampus. According to RTOG-0933 study criteria, 18 patients (82%) were treated within constraints and four patients (18%) had unacceptable deviation in just one hippocampus. CONCLUSIONS: This dosimetric quality assurance study shows good compliance (82%) according to RTOG-0933 study dosimetric constraints. Indeed, all patients respected RTOG hippocampal avoidance constraints on at least one hippocampus. In the futureanalysis of the WBRT-Mel trial, the NCF of patients on the observation arm, WBRT arm and with HA-WBRT arm will be compared. FAU - Martinage, Geoffrey AU - Martinage G AD - Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia. AD - Centre Oscar-Lambret, Lille, France. AD - Mater Hospital, NSW, North Sydney, Australia. FAU - Hong, Angela M AU - Hong AM AD - Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia. AD - Mater Hospital, NSW, North Sydney, Australia. AD - GenesisCare, Radiation Oncology, Mater Hospital, NSW, North Sydney, Australia. AD - Central Clinical School, The University of Sydney, Camperdown, NSW, Australia. FAU - Fay, Mike AU - Fay M AD - School of Medicine and Public Health, University of Newcastle, NSW, Callaghan, Australia. AD - GenesisCare, Radiation Oncology, NSW, Newcastle, Australia. FAU - Thachil, Thanuja AU - Thachil T AD - Northern Territory Radiation Oncology, Alan Walker Cancer Care Centre, NT, Darwin, Australia. FAU - Roos, Daniel AU - Roos D AD - Royal Adelaide Hospital, Adelaide, South Australia, Australia. AD - University of Adelaide, South Australia, Adelaide, Australia. FAU - Williams, Narelle AU - Williams N AD - Australia and New Zealand Melanoma Trials Group, NSW, North Sydney, Australia. FAU - Lo, Serigne AU - Lo S AD - Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia. AD - Central Clinical School, The University of Sydney, Camperdown, NSW, Australia. FAU - Fogarty, Gerald AU - Fogarty G AD - Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia. Gerald.fogarty@cancer.com.au. AD - Mater Hospital, NSW, North Sydney, Australia. Gerald.fogarty@cancer.com.au. AD - GenesisCare, Radiation Oncology, Mater Hospital, NSW, North Sydney, Australia. Gerald.fogarty@cancer.com.au. AD - Central Clinical School, The University of Sydney, Camperdown, NSW, Australia. Gerald.fogarty@cancer.com.au. LA - eng GR - 1084046/Cancer Australia/ PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20180720 PL - England TA - Radiat Oncol JT - Radiation oncology (London, England) JID - 101265111 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Australia MH - Brain Neoplasms/*radiotherapy/secondary MH - Cranial Irradiation/*methods/standards MH - Dose Fractionation, Radiation MH - Female MH - Hippocampus/*radiation effects MH - Humans MH - Male MH - Melanoma/*radiotherapy/secondary MH - Middle Aged MH - Organ Sparing Treatments/*methods/standards/statistics & numerical data MH - *Quality Assurance, Health Care MH - Radiation Injuries/*prevention & control MH - Radiosurgery/methods/standards MH - Radiotherapy Planning, Computer-Assisted MH - Radiotherapy, Intensity-Modulated/*methods/standards MH - Retrospective Studies MH - Young Adult PMC - PMC6053726 OTO - NOTNLM OT - Hippocampal avoidance OT - Intensity-modulated radiotherapy OT - Quality assurance OT - Radiotherapy OT - Trial OT - Whole brain radiotherapy COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The WBRT-Mel Trial protocol and amendment to include HA-WBRT were approved by the Ethics Review Committee (RPAH Zone) of the Sydney Local Health District (Protocol No. X13-0329 & HREC/13/RPAH/465). All trial participants provided written informed consent. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/07/22 06:00 MHDA- 2019/01/29 06:00 PMCR- 2018/07/20 CRDT- 2018/07/22 06:00 PHST- 2018/04/26 00:00 [received] PHST- 2018/07/11 00:00 [accepted] PHST- 2018/07/22 06:00 [entrez] PHST- 2018/07/22 06:00 [pubmed] PHST- 2019/01/29 06:00 [medline] PHST- 2018/07/20 00:00 [pmc-release] AID - 10.1186/s13014-018-1077-z [pii] AID - 1077 [pii] AID - 10.1186/s13014-018-1077-z [doi] PST - epublish SO - Radiat Oncol. 2018 Jul 20;13(1):132. doi: 10.1186/s13014-018-1077-z.