Tumori Journal

Breast cancer is the most frequently occurring cancer among females and the second most common cancer overall. Programmed Cell Death Ligand 1 (PD-L1) plays an important role in blocking ‘cancer-immunity cycle’ and is considered as a major inhibitory pathway. The aim of the present study was to clarify the alterations of expression of PD-L1 in peripheral blood mononuclear cytes (PBMCs) of female breast cancer patients and analyze its association with clinico-pathological criteria as well as therapeutic response.

The study was conducted on 45 female breast cancer patients and 45 female controls. Blood samples were collected followed by PBMCs isolation, total RNA extraction, reverse transcription and finally, quantitative polymerase chain reaction (qPCR) using SYBR Green DNA binding dye. Expression levels of PD-L1 were calculated and then compared with clinicopathological parameters of the patients in addition to initial therapeutic response.

A significant difference was detected for PD-L1 expression levels in breast cancer patients compared to controls. A significant association with age, metastatic breast cancer, estrogen receptor (ER) negative status as well as high concentrations of cancer antigen 15-3 (CA15-3) was detected. On the other hand, no significant association was recognized with tumor size, lymph nodal status, histopathological type, grade, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, triple negative, among de novo and recurrent metastatic patients and for the number of metastatic sites as well as the therapeutic response.

This study paves the way of the use of PD-L1 as a noninvasive prognostic and diagnostic biomarker for poor prognosis of breast cancer.

Tuberculosis (TB) of the upper genital tract is a rare disease worldwide. TB should be always considered in the differential diagnosis of a pelvic or adnexal mass as it may diagnosed as ovarian carcinoma but both have completely different treatment. Therefore, recognition of TB is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive therapy.

Granulosa cell tumor of the ovary is a rare type of ovarian cancer that accounts for approximately 2% of all ovarian tumors. This type of tumor is known as a sex cord-stromal tumor and usually occurs in adults.

Thorough search in English literature revealed only 2 case reports showed combination between genital TB and granulosa cell tumor.

A 68 years old female patient complained of vaginal bleeding for four months. She had no personal or family history of TB. An ultrasound study showed a 2x1.5 cm mixed echogenic mass in the right adnexa. Based on her clinical and imaging findings which suggestive of ovarian cancer, the patient underwent panhystrectomy and bilateral salpingoophrectomy. The gross examination of the specimen revealed distended and coiled tubes with right adnexal mass measured 2x1.5 cm and dissection of the uterus revealed erythematous endometrium with yellowish secretions. The histopathologic assessment of right adnexal mass revealed malignant neoplasm *Granulosa cell tumor* formed of short polygonal cells arranged in diffuse sheets with patternless pattern. The malignant cells showed nuclear grooving. There was no necrosis or other ovarian neoplastic element. The histopathologic assessment of both tubes and endometrium revealed infiltration by multiple nodular granulomas. Each granuloma was formed of multinucleated giant cells and epithelioid cells rimmed by lymphocytes with occasional central caseation *genital tuberculosis*.

The conclusion of this case report is to stress upon keeping genital TB in mind as a potential differential diagnosis for ovarian carcinoma.

Clinical findings regarding the impact of BRCA1/2 mutational status on the prognosis of breast cancer patients are still controversial. We aimed to investigate the prognostic relevance of BRCA1/2 mutations on recurrence and long-term survival, for the first time, in Egyptian female breast cancer patients.

The study cohort comprised 103 Egyptian female breast cancer patients previously tested for BRCA1/2 mutations using HRM analysis and direct sequencing. Clinicopathological and long-term clinical follow-up data including date and site of disease progression, were retrieved from medical records until death or loss to follow-up. Outcome measures including overall survival (OS), disease-free survival (DFS), recurrence-free survival, and metastasis-free survival (MFS) were compared in all BRCA1/2 mutation carriers versus non-carriers at 2, 5, 10, and 15 years after diagnosis.

The profile of the detected variants was previously reported. The American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines were used to re-classify the variants. The median follow-up time was 6.9 years (range, 4.2-24.4 years). BRCA carriers had significantly worse DFS than non-carriers, at 2 years 86.7% vs 88.2%; at 5 years 38.1% vs 57.8%; and at 10 years 21.6% vs 34.1% (P=0.024). Negative estrogen receptor (ER) status (HR=2.44, 95%CI=1.33-4.47) and large tumor size (HR=2.19, HR=1.21-3.98) were also significant factors for worse DFS. Recurrence-free survival was significantly worse in BRCA carriers compared to non-carriers, at 5 years: 95.2%vs 98.2%; at 10 years: 54.4% vs 79.8%; and at 15 years 34.6% vs 61.7% (P=0.005). BRCA carriers showed poorer OS and MFS, though not statistically significant [OS in BRCA carriers and non-carriers at 5 years: 81.6% vs 89.3%; at 10 years: 59.2% vs 60.6%; and at 15 years: 36.3 vs 59.2% (P=0.42); and MFS at 2 years 86.7% vs 88.1%; at 5 years 44.5% vs 61.1% ; and at 10 years: 25.3% vs 38.2% (P=0.41)].

To our knowledge, this is the first study in the Middle East to investigate long-term survival outcome of BRCA1/2 related breast cancer. We, herein, underline the necessity of implementing BRCA screening strategies and intensive surveillance in the mainstream oncology practice in Egypt.

The standard treatment of hormone receptor positive Her2 negative metastatic breast cancer is endocrine therapy with or without targeted therapy (e.g.CDK4/6inhibitors and mTOR inhibitors). Chemotherapy is indicated only in visceral crisis and the presence of visceral metastases is not indication for chemotherapy

The study identified 611 women with hormone receptor positive metastatic breast cancer, median age was 50years, 48.9% were postmenopausal, 56.7% of hormone receptor positive, Her2 negative patients received chemotherapy as first line systemic treatment, 69.5% of these patients received chemotherapy as first line treatment in the first 5years. But, 48.8% of these patients received chemotherapy as first line in the last 5years and the study showed that median overall survival for all studied patients was 34 months.

In contrast, the physician questionnaire showed that 75% of physicians prefer endocrinal therapy as first line treatment for hormone receptor positive, Her2 negative metastatic breast cancer.

There is significant change in practice pattern in choosing the first line treatment between the first and last 5 years. Also, there is a discrepancy between practice pattern and physician preferences in choosing the first line systemic treatment for hormone receptor positive, Her2 negative metastatic breast cancer. The reason is the unavailability of most targeted agents (e.g; CDK4/6 inhibitors and mTOR inhibitors) and some hormonal agents such as fulvestrant.

Triple negative breast cancer (TNBC) is an aggressive form of breast cancer associated with a poor prognosis. No targeted treatment is available for this subtype. Tumor microenvironment (TME) has been increasingly considered a diagnostic and a prognostic biomarker and a therapeutic target for breast cancer. Tumor associated macrophages (TAM) are a pivotal member of TME and have been proposed as potential targets of therapy.

The immunohistochemical expression of CD68+ve TAM was studied in both tumor stroma (TS) and tumor nest (TN) in 50 cases of triple negative invasive ductal carcinoma as well as in 10 control cases of benign breast lesions.

The cases were divided into high or low density groups according to the median. The median in CD68+ve TAM in TS was (61.88), while in CD68+ve TAM in TN was (49.88). The expression of CD68+ve TAM in TS was low in 22 cases and high in 28 cases, while its expression in TN was low in 35 cases and high in 15 cases. There was no statistical association between high CD68+ve TAM in TN and different clinicopathological parameters, meanwhile a statistically significant association was found between high CD68 +ve TAM in TS and tumor grade, lymph/vascular invasion and lymph node metastasis.

High expression of TAM in TS, but not in TN, is of clinical significance in patients with TNBC and highlights the importance of analyzing the localization rather than merely the presence of TAM as a marker for prognosis and a potential target for future treatment of triple negative breast cancer.

The efficacy and safety of the lapatinib based treatment remain challenging in elderly patients with her2neu positive metastatic breast cancer (MBC).

Lapatinib exhibits a good overall tolerance, but no study has yet been dedicated to elderly women.

The present study is a real-world study that aimed to determine the efficacy and tolerability of the lapatinib-based treatment in the first line setting in Egyptian patients with HER2neu positive MBC who cannot get access to trastuzumab.

In this retrospective study, 60 elderly patients (⩾ 65 years) with her2neu positive MBC and treatment naïve were included.

All patients were treated with the combination of lapatinib (1,250 mg/day, continuously) and chemotherapy (either capecitabine 2,000 mg/m2 on days 1–14 of a 21-day cycle or weekly taxol 80 mg/m²), or lapatinib (1,250 mg/day, continuously) and hormonal treatment.

Data on demographics, clinical outcome, and toxicity were collected form the patients’ medical records for descriptive analyses.

The median follow-up was 23.5 months (range 11–36 months). Most of the patients were hormone receptor positive (70%). About 28% of the patients had multiple sites of metastasis while 16 patients (26.7%) had bone only metastasis and 11 patients (18.3%) had lung only metastasis. Most of our patients (63.3%) had no associated comorbidities.

An overall response rate of 61.7% was achieved, including 2 complete responses (3.3%), and 13 partial responses (21.7%).

Median progression-free survival was 15.9 months (95% confidence interval (CI) 13.56- 18.33), and the median overall survival was 19.9 months (95% CI 17.8-21.9).

Most common grade 1-2 side effects were diarrhea (43.3%), followed by hand-foot syndrome (35%), and skin rash (13.3%). Grade 3–4 toxicities were identified as hand-foot syndrome (10%), diarrhea (6.6%).There were no symptomatic cardiac events.

Tolerability data show that 45% of patients needed a lapatinib dose reduction, and 30% a treatment interruption due to toxicity, while treatment discontinuation occurred in 18.3% of the cases.

Lapatinib based therapy in elderly patients with her2neu positive MBC was effective. However, it was not well tolerated especially when combined with chemotherapy.

Vulvar verrucous carcinoma (VC) is extremely rare, accounting for less than 1% of vulvar cancer cases. Effectively, it is characterization by a slow growing, no metastasis or lymph node involvement.

The aim of this study was to report our experience with this disease

This is a retrospective study of patients with vulvar VC who were treated at National Institute of Oncology between 2013 and 2018. Clinicopathological characteristics, treatment and follow-up were extracted from the medical records.

Three cases were identified in the National Institut of Oncology. The average age at diagnosis was 66 years (± 10.02). The average time from the onset of symptoms to diagnosis was 17 months (± 12,7). All patients complained of a vulvar mass or nodule, accompanied by vulvar pruritus and/or pain, which was the reason for consultation. A preliminary pathological diagnosis of squamous cell carcinoma was made in two cases. Surgical treatment included wide local excision, radical vulvectomy with lymph node dissection in the groin. Tumor size and invasion depth ranged from 50 to 105 mm and 17 to 35 mm respectively. In the final histology, VC of the vulva staged IB (2 cases) and staged III (1 case) with marginal limits in two cases. The concurrent radiochemotherapy was performed in one case, exclusive radiotherapy in one case and only surgery in one case.

Regarding toxicity after concurrent radiochemotherapy and exclusive radiotherapy we had observed respectely grade 2 proctitis with renal toxicity and grade 2 radiodermatitis.

The mean follow-up was 43 months with no recurrence in all cases.

The prognosis is good, with low recurrent rate if wide local excision is performed.

Vulvar VC is a distinct type of slow-growing, tumor with unclear etiology. Surgery is the most effective treatment. Concurrent radiochemotherapy indicated depending on disease stage and risk factors.

Bone metastatic disease affect a patient’s quality of life.

Evaluating possible stratification factors affecting the efficacy of different schedules of zoledronic acid on SREs.

A randomized, clinical trial at Zagazig university hospitals. 108 Patients were enrolled to receive zoledronic acid 4 mg (A and B groups=12 and 4 weeks, respectively) for 2 years.

Regarding age, tumour type, types of bone metastasis and number of bone metastasis, there was an insignificant difference between both groups. However, 3 monthly regimen of zoledronic acid gave better results in solitary than multiple bone metastases. Regarding pretreatment ECOG, there was an insignificant difference between between both groups. However, 3 monthly regimen of zoledronic acid gave better results in pre-treatment ECOG 1and ECOG 2 than ECOG 3.

A 3-monthly regimen of zoledronic acid is more effective in management of solitary or few sites of bone metastasis, osteoblastic bony lesions and patients with good performance status.

We recommend a larger sample size and the study should include a homogenous groups of patients so we can judge well on different stratifications factors that can affect efficacy of 3- monthly regimen of zoledronic acid.

Treatment of locally advanced nasopharyngeal (Npx) cancer usually requires the inclusion of the sphenoid body or higher in intermediate risk CTV dose regions. This makes the avoidance of intracranial OAR such as temporal lobes, optic apparatus and cochlea challenging. There are different accumulating data confirming the impact of hippocampus (HC) irradiation on neurocognitive functions after whole brain radiotherapy & Npx cases were specifically addressed in several publications. The specified dose constrain in RTOG 0933 was D_max <9 Gy.

Our aim is to retrospectively evaluate the doses delivered to the HC in patients with locally advanced Npx carcinoma.

Our study included twelve patients with locally advanced nasopharyngeal carcinoma (Stage III-IVA) previously treated at NEMROCK by either IMRT or VMAT. The HC was retrospectively delineated without being accounted for in the inverse treatment planning. Bilateral HC were delineated as a single OAR, and a margin of 3 mm was added to create the HC zone. We evaluated the doses delivered to the hippocampus by conducting a dosiemtric analysis on the treatment plan already used.

DVH Analysis: The mean volumes (std) for PTV70 primary, PTV70 LN and PTV59.4 were 83.62 cm³ (±33.51), 119.5 cm³ (±122.66) and 1017.58 cm³ (±140.28) respectively. The mean HC volume (std) was 4.17 cm³ (±1.66).

The mean HC Dmin, Dmean, Dmedian and Dmax were 6.57 Gy, 25.05 Gy, 24.18 Gy and 52.95 Gy respectively. The mean HC V₅, V₁₀, V₂₀, V₄₀, V₅₀ and V₆₀ were 92.83%, 78.95%, 55.91%, 20.37%, 9.9% and 3.38% respectively. There was no difference between IMRT and VMAT in terms of HC volumetric and dosimetric parameters.

In locally advanced Npx carcinoma, HC is exposed to significant doses, particularly with T4 disease (intracranial extension). In view of the low radiation tolerance of HC and its close proximity to CTV54-60 Gy in Npx cases, HC contouring and avoidance should be considered.

The aim of this prospective study was to evaluate the correlation of primary (1ry)tumor metabolic activity parameters maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) in initial staging 18F-fluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan with clinical, histopathological and molecular characteristics of breast cancer (BC) patients.

Initial staging PET/CT was performed in 40 cases with different stages of BC in the supine position. Tumor FDG uptake was qualitatively evaluated and quantitatively assessed using SUVmax and TLR.

Forty female patients with newly diagnosed BC were enrolled in our study, age range from 31-78 (mean 50.5 +/- SD11.7).

All the 1ry tumors were detected with mean SUVmax 10.8(+/-SD 7.9). The mean /median SUVmax values of 1ry tumor was higher in premenopausal, stage III& IV, Estrogen Receptors negative(ER-), Progesteron Receptors negative(PR-), Her2neu positive patients, high nuclear grade (GIII), in triple negative molecular subgroup (TN), positive axillary nodal (ALNs)metastases, and (P value = 0.003, 0.017, 0.113, 0.089 0.01,0.002, 0.007 & 0.016 respectively).

The mean/median TLR values was higher in premenopausal and Her2neu positive, GIII, TN molecular subtype patients, stage III& IV and in patients with positive ALNs, ER- &PR - patients (P value = 0.002, 0.0476, 0.005, 0.018, 0.039 and 0.022, 0.095 & 0.129 respectively).

SUVmax of the 1ry lesion and TLR were moderately negatively correlated with the age of the patients (P value = 0.005 and 0.008 respectively), also they were moderately positively correlated with the size of the1ry tumor (P value = 0.019 and 0.036 respectively).

The SUVmax of the 1ry tumor and TLR values had similar significant associations with different prognostic factors in BC

Inflammatory Breast Cancer (IBC) is a rare and very aggressive breast cancer with poor prognosis. The prevalence is different from a country to another. In Tunisia, it is about 5 to 7% of breast cancer.

The aim of this study is to describe the epidemiological and histopathological features of patients with inflammatory breast cancer and to evaluate the treatment response according to the molecular subtypes.

This retrospective review identified 31 patients with no metastatic IBC treated in our radiotherapy department between December 2019 and November 2020. IBC was confirmed using the clinical criteria. Baseline clinic-pathological and treatment information was retrieved from medical records. Statistical analysis was performed with IBM SPSS V.20.

Median age was 51.3 years [27-68]. 48% of tumors were grade 3. The average tumor size was 36mm [10-90]. The histological type was ductal carcinoma in 97%. Vascular invasion was noted in 24 patients (77%). Thirty patients were classified as stage IIIB and one patient was IIIC. 74% were hormone receptor positive and 45% were HER2 positive. Luminal B was the predominant subtype (52%) followed by Her2 positive (32%), Luminal A (23%), and triple negative (3%)

All patients had chemotherapy: neoadjuvant for 26 patients (84%) and adjuvant for 5 patients (16%). Nine patients (29%) had tumor pathological complete response (pCR). Partial response was observed in 18 patients (58%). Lymph node pCR was noted in 16% of cases (n=5). Endocrine therapy and trastuzumab were given to 76% and 45% of patients, respectively. The influence of the molecular subtype was not statistically significant on the response to neoadjuvant treatment. The highest rate of pCR were 43% for Her2positive, then 27%, 21% and 9% for Luminal B, Luminal A and Triple negative, respectively (p=0.2).

Our study showed a high percentage of hormone receptor and Her2+ (74% and 45% respectively) in IBC. Luminal B was the most frequent subtype. Anthracycline-based chemotherapy and trastuzumab improved the pCR rate: 44% for Her2positive. Triple negative showed poorer pCR than other breast cancer subtype without a significant difference. A larger study is warranted to confirm our findings.

Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis.

This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study.

The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A).

Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.

Radical mastectomy shall be a lifesaving procedure for patients with breast cancer. However, it is associated with considerable alteration of patients’ self-esteem and body image. Currently, 40% of women are subjected to breast reconstruction subsequent to radical mastectomy, ranking such surgery the most common reconstruction approach. Two-stage tissue expander-to-implant is the preferable technique that accomplished the desired aesthetic outcomes. The current study was executed to assess the safety and efficacy of Carbon-dioxide based tissue expansion, in contrast to saline-based tissue expansion.

Comprehensive literature review up to 1 December 2020 was carried out throughout the following databases; PubMed, Google Scholar, Web of Science, Scopus, WHO Global Health Library, Clinical trials, Cochrane, SIGLE, NYAM, mRCT, and ICTRP to identify all clinical studies compared carbon-dioxide based and saline-based tissue expansion. Data analysis was done using Review Manager version 5.3 (RevMan5.3). The significant difference was established at P < 0.05.

This meta-analysis included four articles which comprised 619 reconstructed breasts. Of them, 374 breasts were reconstructed using carbon-dioxide based tissue expander, whereby 245 breasts were reconstructed using saline-based tissue expander. Carbon-dioxide based tissue expander accomplished statistically significant shorter duration to accomplish complete expansion (MD-36.28;95%CI-44.09,-28.47;P<0.001) and shorter duration to achieve complete reconstruction (MD-41.91;95%CI-54.24,-29.58;P<0.001). There was no statistically significant difference between carbon-dioxide and saline-based tissue expanders regarding the success rate (RR 1;95%CI 0.96, 1.06;P=0.85), device malfunction (RR 0.94;95%CI 0.11, 8.06;P=0.96), and implant extrusion (RR 0.71;95%CI 0.14, 3.62;P=0.68). There was no statistically significant difference between both methods regarding total; complications (RR 0.93;95%CI 0.64, 1.37;P=0.72). This includes wound infection (RR 0.46;95%CI 0.08, 2.72;P=0.39), wound dehiscence (RR 0.47;95%CI 0.10, 2.25;P=0.34), seroma (RR 1.01;95%CI 0.40, 2.57;P=0.99), and hematoma (RR 0.28;95%CI 0.06, 1.29;P=0.1).

Carbon-dioxide based tissue expander is a safe, effective, and promising approach with considerable advancement relative to saline-based tissue expander, principally regarding the time to accomplish complete implant expansion and the time to achieve complete breast reconstruction.

Breast cancer is a disease which have a variety of important features whose different phenotype only partially summarize the underlying biological complexity. Treatment choices in routine management principally rely on the clinical and pathological characteristics of the disease, although molecular classification currently offers information alongside that provided by clinical and pathological examination. The decision to offer adjuvant chemotherapy to patients is not easy and the knowledge of prognostic factors is mandatory. Ki 67 plays an important role in this context, especially in patients who do not have access to genetic signatures.

This study aims to evaluate the value of Ki67 as a prognostic factor in relation to disease free survival and other clinico-pathological factors in Egyptian females with early stage breast cancer.

Type of study: This is a retrospective cohort study. Study population: It consisted of 124 patients diagnosed with early stage breast cancer. Study Period: They were diagnosed between January 2011 and December 2015. Study setting: The patients were following up in Ain Shams University Hospital clinical oncology department. Information were manually retrieved from the records of the clinical oncology department at Ain Shams university hospitals. Clinical and pathological tumor characteristics were collected using patient charts and pathology reports.

Our study showed a significant relation between Ki67 index and estrogen receptors, progesterone receptors and Her2 neu status. Ki67 was found to be statistically significantly correlated to intrinsic subtypes. Our study was unable to find out the effect of Ki67 on disease free survival. Cox regression analysis revealed a statistical significant influence of estrogen receptors status on disease free survival. It also revealed statistical prognostic effect of progesterone receptors and Her2 status on disease free survival. Covariate analysis of results in our study showed that tumor with T4 stage has a significant prognostic effect on disease free survival.

ki67 index may have a prognostic role in management of early stage breast cancer in relation to other prognostic markers like hormone receptor status and HER2neu expression. Moreover, immunohisto-chemistry-based subtyping is extremely important to classify breast carcinoma into molecular subtypes that vary in clinic-pathological features and would lead to different prognosis. Thus, molecular subtyping is essential for breast carcinoma management.

Whole brain radiotherapy is the treatment of choice for patients with brain metastases. However, neurocognitive functions decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT might provide meaningful neurocognitive functions preservation.

Our study aims to demonstrate the impact of delivering HA‑WBRT on NCF changes in patients receiving WBRT.

fifty patients who were referred for cranial irradiation were enrolled in the study. Before the HA‑WBRT course and randomly assigned to two equal groups, the first group will receive conventional whole brain palliative radiotherapy and the second group will receive hippocampal sparing whole brain radiotherapy, assigned to 30 Gy over 10 fractions over two weeks, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed,the primary endpoint was delayed recall, as determined by the change/decline in Hopkins Verbal Learning Test (HVLT-R) and The One Card Learning Test (OCLT) from the baseline assessment to 4 months after the start of HA‑WBRT.

Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post‑radiotherapy intervals, in immediate verbal memory and non‑verbal memory, except for delayed recall memory on HVLT-R Hopkins Verbal Learning Test -Revised for delayed recall Learning, p =0.008.

Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA‑WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control.