脑转移是一个主要问题，大约 50% 的患者可能会在小细胞肺癌 (SCLC) 的临床过程中发生脑转移。由于预防性颅脑照射可降低脑转移的发生率并提高总体生存率，因此建议对无远处转移或广泛分期且对全身治疗反应良好的 SCLC 患者进行预防性颅脑照射。避免海马的全脑放疗 (HA-WBRT) 是保留海马功能的首选，同时最大限度地减少负面认知影响。将海马的剂量减少到低于治疗性脑剂量可能会增加海马进展的风险；因此，HA-WBRT可能与海马周围复发的风险相关。3名SCLC患者接受HA-WBRT并在临床随访期间出现颅内衰竭； 3例分别在12、13和7个月后复发并出现海马周围区域颅内衰竭。与病例的治疗脑剂量和HA区域周围的剂量不足区域相比，我们将颅内衰竭的MRI扫描与先前的模拟计划扫描进行匹配并发现海马周围衰竭中剂量不足区域的偏差约为 55% 至 63%。海马周围衰竭是 SCLC 患者接受 HA-WBRT 后的罕见临床结果。海马周围衰竭可能是由于辐射剂量不足或癌症本身的侵袭性引起的。鼓励对此主题进行更多研究。作者版权所有 © 2024。由 Wolters Kluwer Health, Inc. 出版

Brain metastasis is a major concern, and may occur in roughly 50% of patients during the clinical course of small cell lung cancer (SCLC). Because prophylactic cranial irradiation reduces the incidence of brain metastases and improves overall survival, prophylactic cranial irradiation is recommended for SCLC patients without distant metastases or an extensive stage and have responded well to systemic therapy. Hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) is preferred to preserve hippocampal function while minimizing negative cognitive effects.Reducing the dose delivered to the hippocampus below the therapeutic brain dose may increase the risk of hippocampal progression; thus, HA-WBRT may be associated with a risk of perihippocampal recurrence.Three patients with SCLC received HA-WBRT and developed intracranial failure during clinical follow-up; 3 relapsed with intracranial failure in the perihippocampal region after 12, 13, and 7 months, respectively.Compared to the therapeutic brain dose of cases and the underdose region around the HA region, we matched MRI scans of intracranial failure and previous planning scans of simulation and found a deviation of the underdosed region within the perihippocampal failure of approximately 55% to 63%.Perihippocampal failure is a rare clinical outcome in SCLC patients following HA-WBRT. Perihippocampal failure could be caused by an underdose of radiation or by the aggressiveness of the cancer itself. More research into this topic is encouraged.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.