Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 20;6(1):vdae040.
doi: 10.1093/noajnl/vdae040. eCollection 2024 Jan-Dec.

Hippocampal subfield volumetric changes after radiotherapy for brain metastases

Klara Holikova  1 , Iveta Selingerova  2 , Petr Pospisil  3   4 , Martin Bulik  1 , Ludmila Hynkova  3   4 , Ivana Kolouskova  5   6 , Lucie Hnidakova  3   4 , Petr Burkon  3   4 , Marek Slavik  3   4 , Jiri Sana  5   7 , Tomas Holecek  1   2   8 , Jiri Vanicek  1 , Pavel Slampa  3   4 , Radim Jancalek  9   10 , Tomas Kazda  3   4
Affiliations

Hippocampal subfield volumetric changes after radiotherapy for brain metastases

Klara Holikova et al. Neurooncol Adv. .

Abstract

Background: Changes in the hippocampus after brain metastases radiotherapy can significantly impact neurocognitive functions. Numerous studies document hippocampal atrophy correlating with the radiation dose. This study aims to elucidate volumetric changes in patients undergoing whole-brain radiotherapy (WBRT) or targeted stereotactic radiotherapy (SRT) and to explore volumetric changes in the individual subregions of the hippocampus.

Method: Ten patients indicated to WBRT and 18 to SRT underwent brain magnetic resonance before radiotherapy and after 4 months. A structural T1-weighted sequence was used for volumetric analysis, and the software FreeSurfer was employed as the tool for the volumetry evaluation of 19 individual hippocampal subregions.

Results: The volume of the whole hippocampus, segmented by the software, was larger than the volume outlined by the radiation oncologist. No significant differences in volume changes were observed in the right hippocampus. In the left hippocampus, the only subregion with a smaller volume after WBRT was the granular cells and molecular layers of the dentate gyrus (GC-ML-DG) region (median change -5 mm3, median volume 137 vs. 135 mm3; P = .027), the region of the presumed location of neuronal progenitors.

Conclusions: Our study enriches the theory that the loss of neural stem cells is involved in cognitive decline after radiotherapy, contributes to the understanding of cognitive impairment, and advocates for the need for SRT whenever possible to preserve cognitive functions in patients undergoing brain radiotherapy.

Keywords: brain; hippocampus; metastasis; radiotherapy; volumetry.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the writing of the manuscript and in the decision to publish this article.

Figures

Figure 1.
Figure 1.
FreeSurfer software version 7.1.1 for semiautomatic segmentation of subhippocampal regions. Amygdala regions were not included as hippocampal subregions. Abbreviations: CA, Cornu Ammonis; GC-ML-DG, granule cell and molecular layer of the dentate gyrus; HATA, hippocampus amygdala transition area; HP, hippocampus
Figure 2.
Figure 2.
Differences in the volume of left and right GC-ML-DG-body in the control SRT as well as WBRT group. Abbreviations: GC-ML-DG, granule cell and molecular layer of the dentate gyrus; SRT, stereotactic radiotherapy; WBRT, whole-brain radiotherapy; RT, radiotherapy
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Le Rhun E, Guckenberger M, Smits M, et al.; EANO Executive Board and ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Ann Oncol. 2021;32(11):1332–1347. - PubMed
    1. Lehrer EJ, Jones BM, Dickstein DR, et al.. The cognitive effects of radiotherapy for brain metastases. Front Oncol. 2022;12:893264. - PMC - PubMed
    1. Gondi V, Tomé WA, Mehta MP.. Why avoid the hippocampus? A comprehensive review. Radiother Oncol. 2010;97(3):370–376. - PMC - PubMed
    1. Brown PD, Gondi V, Pugh S, et al.; for NRG Oncology. Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: Phase III Trial NRG oncology CC001. J Clin Oncol. 2020;38(10):1019–1029. - PMC - PubMed
    1. Brown PD, Jaeckle K, Ballman KV, et al.. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: A randomized clinical trial. JAMA. 2016;316(4):401–409. - PMC - PubMed

LinkOut - more resources