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

ABSTRACT This study aimed to investigate whether hippocampal avoidance (D 40 < 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 D 40 < 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 D 40 ≤ 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 D 40 > 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 D 40 < 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.