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Conclusions (late toxicity)
1. CNS toxicity is dose dependant and volume dependant
2. Metrics/dose constraints are based on studies with varying parameters
(target volume, sample size, radiation modality, brain region, etc…)
3. Brain necrosis after (very) high-dose RT frequent: 10-15% @ 5 years
4. Is usually symptomatic and requires therapy
5. Risk factors: Gender?, DVH metrics
6. Pituitary dysfunction: very common for GHD but not treated in the majority
of cases
7. GH replacement for cancer patient: no evidence of tumor recurrence
8. Constraints mean dose to cochlea to < 43-45 Gy
9. Constraint dose to 60 and 55-56 Gy to the ON and OC, respectively.
10. Correlation between hippocampal irradiation and neuro-cognitive toxicity
11. Hippocampal avoidance in young patients with LGG or benigh tumors?
03/01/13