Effects of Hippocampal Avoidance on Anxiety in Patients With Nasopharyngeal Carcinoma Undergoing Intensity-Modulated Radiotherapy: A Single-Center, Single-Arm, Prospective Clinical Trial.

This study aimed to investigate whether hippocampal avoidance (D40 < 15 Gy) could reduce anxiety incidence in patients with nasopharyngeal carcinoma (NPC) undergoing intensity modulated radiation therapy (IMRT), and to dynamically assess the anxiety incidence at 3 and 6 months after radiotherapy. A single-center, single-arm prospective clinical trial was conducted, enrolling eligible NPC patients who underwent hippocampal-sparing IMRT with the hippocampal D40 < 15 Gy. 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, 3- and 6-month 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 patients developed anxiety (0/34, 0%), 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-month post-radiotherapy compared with pre-radiotherapy levels. Dosimetric evaluation confirmed acceptable target coverage, conformity, and homogeneity index. Collectively, hippocampal avoidance with bilateral D40 < 15 Gy was associated with a low incidence of anxiety in NPC patients undergoing IMRT without compromising target dose or cognitive function, providing a novel approach to improve quality of life.