Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?

Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus.

I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in the sagittal view for confirmation and to smooth out any jagged steps.

Regarding the poll question, I do use hippocampal-sparing IMRT for small cell lung cancer at the time of relapse, and this is supported by the current NCCN guidelines for Small Cell lung cancer with Brain Metastasis, under Principles of Radiation Therapy.

This NCCN guideline also states that selected patients with brain oligomets from small cell lung are candidates for SRS/SRT, ...

Thank you to theMednet for the opportunity to address this important question. This reply was generated in collaboration with Dr. @Dr. First Last and Dr. @Dr. First Last.

We would recommend hippocampal avoidance (HA) using IMRT during WBRT for patients with brain metastases from small cell lung cancer, including at the time of presentation, i.e., extensive-stage small cell lung cancer (ES-SCLC).

In addressing this question, our first consideration is prognosis. NRG CC001 identified multi-dimensional neurocognitive and quality of life benefits with HA during WBRT, but only in patients who lived 4 months or longer. The CASPIAN trial (Paz-Ares et al. Lancet 2019), which included patients with brain metastases, reported a median survival of 13 m...

I would love to use that, but I trained many eons ago, and don't feel confident that I can accurately delineate the hippocampus. I don't have neuroradiology available, and also don't have easy access to radiology for assistance.