To evaluate whether the results of the AD hippocampus could be applied to clinical practice directly, we used 11 cases in testing cohort c to generate radiotherapy plans. All of the 11 cases had CT images scanned in the same position as MR images with a 1 mm slice thickness. The MR images were fused with the CT images and the hippocampus and HC-PRV on the MRI were copied to the CT images to generate radiotherapy plans. We defined the target volumes (TVs) as follows: the hippocampus was expanded by 5 mm in all three dimensions to form the planning risk volume (HC-PRV), the clinical target volume (CTV) was defined as the whole-brain, and the planning target volume (PTV) was defined as CTV expanded by 5 mm in three dimensions excluding the HC-PRV.

Radiotherapy plans were made on Varian Eclipse Treatment Planning (Varian Medical System, USA) using the Intensity Modulated Radiation Therapy (IMRT) technique. The radiation field distribution is listed in detail in Additional file 1: Table S1, and a 7-coplanar field and 4-non-coplanar field arrangement was used for the IMRT plan (Fig. 3). The radiation dose of 10 × 3 Gy was prescribed to 95% of the PTV (V30Gy ≥ 95%) and the optimization parameters are listed in Additional file 1: Table S2. Dose constraints of normal tissue were referred to the RTOG 0933 protocol. Briefly, the mean dose of the hippocampus could not exceed 9 Gy, and the maximal hippocampal dose could not exceed 16 Gy. Both the AD and MD hippocampus were used to generate radiotherapy plans recorded as Plan (AD) and Plan (MD), respectively.

Distribution of the radiation field. Hippocampus (yellow line); Hippocampus planning risk volume (red line). 7-coplanar field (beam 1–7) and 4-non-coplanar field (beam 8–11) arrangement was used

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