Single-center prospective trial of effects of hippocampal avoidance on anxiety in patients undergoing IMRT for nasopharyngeal carcinoma

A prospective trial at Fujian Medical University (Fuzhou, China) investigated whether hippocampal avoidance (hippocampal D₄₀ < 15Gy) could reduce anxiety incidence in patients with nasopharyngeal carcinoma (NPC) undergoing IMRT. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety, and the Mini-Mental State Examination (MMSE) was applied to evaluate cognitive function. Assessments were conducted at pre-radiotherapy, end of radiotherapy, and 3- and 6- months post-radiotherapy. All 37 enrolled patients met the criterion of hippocampal D₄₀ ≤ 15 Gy. The incidence of anxiety was 0% (0/37) at the end of radiotherapy, which was lower than the 30.8% observed in the historical control group with hippocampal D₄₀ > 15 Gy (p=0.001). At 3 months post-radiotherapy no patient developed anxiety (0/34), and the incidence was 3.0% (1/33) at 6 months. The median MMSE score remained 29 from pre-radiotherapy to the end of radiotherapy, and no significant decline in MMSE scores was observed at 3 and 6 months post-radiotherapy compared with pre-radiotherapy levels. Dosimetric evaluation confirmed acceptable target coverage, conformity, and homogeneity index. The authors conclude that hippocampal avoidance was associated with a low incidence of anxiety in NPC patients undergoing IMRT without compromising target dose or cognitive function (graphical abstract).