{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:09:22Z","timestamp":1790208562102,"version":"4.1.0"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T00:00:00Z","timestamp":1745712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Brain radionecrosis is an under-recognized but potentially life-altering late complication of radiotherapy in patients with locally advanced nasopharyngeal cancer. Temporal lobe radionecrosis and high-dose exposure to the hippocampus are strongly associated with cognitive decline and radiation-induced dementia, negatively impacting patients\u2019 long-term quality of life (QoL). This study aimed to evaluate and compare radiation dose distributions to critical brain structures across three radiotherapy techniques\u20143D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT)\u2014in order to assess potential neurocognitive risks and support hippocampal-sparing protocols. Materials and Methods: Ten patients previously treated with 3D-CRT were retrospectively replanned using IMRT and VMAT techniques on the Eclipse v13.3 (VARIAN) planning system. Bilateral hippocampi and temporal lobes were delineated as organs at risk (OARs) according to the RTOG atlas, and dosimetric parameters including D_max, D_mean, and D_min were recorded. V7.3 values were evaluated for hippocampal avoidance regions. Results: While IMRT and VMAT provided improved target volume coverage and reduced high-dose exposure to many standard OARs, both techniques were associated with increased D_mean and D_min to the hippocampus and temporal lobes compared to 3D-CRT. The highest D_max values to the temporal lobes were observed in 3D-CRT plans, indicating a potential risk of radionecrosis. VMAT plans showed hippocampal mean doses exceeding 10 Gy in some cases, with V7.3 &gt; 40%, breaching established neurocognitive risk thresholds. Conclusions: These findings support the routine delineation of the hippocampus and temporal lobes as OARs in radiotherapy planning for nasopharyngeal cancer. The implementation of hippocampal-sparing strategies, particularly in IMRT and VMAT, is recommended to reduce the risk of radiation-induced cognitive toxicity and preserve long-term QoL in survivors.<\/jats:p>","DOI":"10.3390\/medicina61050810","type":"journal-article","created":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T20:42:37Z","timestamp":1746391357000},"page":"810","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Potential Risk of Cognitive Impairment Due to Irradiation of Neural Structures in Locally Advanced Nasopharyngeal Cancer Treated by Curative Radiotherapy"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6212-8008","authenticated-orcid":false,"given":"Camil Ciprian","family":"Mire\u0219tean","sequence":"first","affiliation":[{"name":"Regional Institute of Oncology, 700483 Ia\u015fi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-3400","authenticated-orcid":false,"given":"C\u0103lin Gheorghe","family":"Buzea","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. N. Oblu\u201d Emergency Clinic Hospital, 700309 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru Dumitru","family":"Zar\u0103","sequence":"additional","affiliation":[{"name":"Regional Institute of Oncology, 700483 Ia\u015fi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana Irina","family":"Iancu","sequence":"additional","affiliation":[{"name":"Oral Pathology Department, Faculty of Dental Medicine, \u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u015fi, Romania"},{"name":"\u201cSt. Spiridon\u201d Emergency Hospital, 700111 Ia\u015fi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drago\u0219 Petru Teodor","family":"Iancu","sequence":"additional","affiliation":[{"name":"Regional Institute of Oncology, 700483 Ia\u015fi, Romania"},{"name":"Oncology and Radiotherapy Department, Faculty of Medicine, \u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u015fi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gu, W., Li, Q., Xi, D., Tian, Y., Mo, J., and Pei, H. (2017). The Hippocampus Sparing Volume Modulated Arc Therapy does not Influence Plan Quality on Locally Advanced Nasopharyngeal Carcinoma Patients. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-03517-y"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kong, C., Zhu, X.Z., Lee, T.F., Feng, P.B., Xu, J.H., Qian, P.D., and Zhang, Y.Q. (2016). LASSO-based NTCP model for radiation-induced temporal lobe injury developing after intensity-modulated radiotherapy of nasopharyngeal carcinoma. Sci. 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