Hippocampal avoidance reduces neurocognitive toxicity from whole brain radiation, but many patients still experience cognitive decline. This small phase 2 trial explored the feasibility of a technique called memory avoidance whole brain radiation (MA-WBRT) in patients with >15 brain metastases. Similar to HA-WBRT, they created an avoidance region surrounding the hippocampi, amygdalae, corpus callosum, and fornix. The target was treated to 30 Gy in 10 fractions using VMAT, and dose to these structures was limited to D100% <9 Gy and D0.03cc <16 Gy. Ten patients were treated with MA-WBRT and in all cases brain metastases were covered with the prescription dose while meeting the D100% constraint. In 8/10 cases, the D0.03cc constraint was met. | Perlow, Adv Radiat Oncol, 2023
