The goal of this review is to summarize the rationale for and feasibility of hippocampal sparing techniques during brain irradiation. Radiotherapy is the most effective non-surgical treatment of brain tumors and with the improvement in overall survival for these patients over the last few decades, there is an effort to minimize potential adverse effects leading to possible worsening in quality of life, especially worsening of neurocognitive function. The hippocampus and associated limbic system have long been known to be important in memory formation and pre-clinical models show loss of hippocampal stem cells with radiation as well as changes in architecture and function of mature neurons. Cognitive outcomes in clinical studies are beginning to provide evidence of cognitive effects associated with hippocampal dose and the cognitive benefits of hippocampal sparing. Numerous feasibility planning studies support the feasibility of using modern radiotherapy systems for hippocampal sparing during brain irradiation. Although results of the ongoing phase II and phase III studies are needed to confirm the benefit of hippocampal sparing brain radiotherapy on neurocognitive function, it is now technically and dosimetrically feasible to create hippocampal sparing treatment plans with appropriate irradiation of target volumes. The purpose of this review is to provide a brief overview of studies that provide a rationale for hippocampal avoidance and provide summary of published feasibility studies in order to help clinicians prepare for clinical usage of these complex and challenging techniques.

Pancreatic cancer is the third leading cause of cancer death in the developed world and is predicted to become the second by 2030. A cure may be achieved only with surgical resection of an early diagnosed disease. Surgery for more advanced disease is challenging and can be contraindicated for many reasons. Neoadjuvant therapy may improve the probability of achieving R0 resection. It consists of systemic treatment followed by radiation therapy applied concurrently or sequentially with cytostatics. A novel approach to irradiation, stereotactic body radiotherapy (SBRT), has the potential to improve treatment results. SBRT can deliver higher doses of radiation to the tumor in only a few treatment fractions. It has attracted significant interest for pancreatic cancer patients, as it is completed quickly, requires less time away from full-dose chemotherapy, and is well-tolerated than conventional radiotherapy. In this review, we aim to provide the reader with a basic overview of current evidence for SBRT indications in the treatment of pancreatic tumors. In the second part of the review, we focus on practical information with respect to SBRT treatment plan preparation the performance of such therapy. Finally, we discuss future directions related to the use of magnetic resonance linear accelerators.

Background and Objectives: Radiotherapy (RT) is a standard component of palliative treatment for brain metastases. The aim of this retrospective analysis of consecutive patients treated between 2017 and 2023 is to analyze overall survival after brain radiotherapy depending on the type of radiotherapy delivered and to monitor the shift from whole-brain radiotherapy (WBRT) to stereotactic radiotherapy (SRS/FSRT) in real-world practice before the era of routinely used modern brain-penetrant targeted therapy. Materials and Methods: A total of 734 patients treated with radiotherapy for brain metastases were analyzed. Clinical data were collected via an electronic hospital information system and radiotherapy details were obtained using the Eclipse™ treatment planning system. The survival analysis divides patients according to cancer types and according to the RT technique used. Results: A total of 734 patients (median age 65.2 years; 50.5% women) were analyzed, with 104 undergoing more than one course of radiotherapy. Lung cancer (42.3%) and breast cancer (17.2%) were the most common primary diagnoses. Median overall survival (OS) after radiotherapy for the entire cohort was 2.8 months (2.6–3.2 months). Survival varied by radiotherapy technique: 2 months for WBRT-based approaches, 5.7 months for stereotactic radiotherapy (SRS/FSRT), and 7 months for combined WBRT and stereotactic treatment. Breast cancer patients had the longest median OS (3.6 months), with substantially improved outcomes in those treated with stereotactic or combined approaches (12.8 and 11.9 months, respectively). A decline in treated patients was observed during the COVID-19 pandemic (notably in 2021) and a consistent increase in the use of stereotactic techniques between 2017 and 2023 was noted. Conclusions: A wide range of radiotherapy techniques are used in the treatment of brain metastases with the primary concern being the prognosis and diagnosis of a patient. A clearly identifiable trend is a shift away from WBRT toward an increased use of targeted stereotactic irradiation techniques for brain lesions. Overall survival varies significantly across primary sites with most favorable outcomes in breast cancer patients irradiated with SRS/FSRT.