The Impact of Stereotactic or Whole Brain Radiotherapy on Neurocognitive Functioning in Adult Patients with Brain Metastases: A Systematic Review and Meta-Analysis

Grinsven, E E van; Nagtegaal, S.; Verhoeff, J.; Zandvoort, M.J.E. van

doi:10.1159/000518848

Cited by 25 publications

(13 citation statements)

References 73 publications

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“…Many institutions have adopted a strategy of combined treatment with ICI and SRS, postponing wholebrain irradiation as long as possible also in patients with 5-10 initial lesions. The literature suggests that SRS-associated toxicity rates are fairly low after such combinations [28][29][30]. In a multicenter study of melanoma patients with previously untreated brain metastases, the addition of radiotherapy (SRS or other regimes) resulted in a favorable OS on systemic therapy [31].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

et al. 2023

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Introduction: Immune checkpoint inhibitors (ICI) have become a mainstay of treatment for different cancer types. The purpose of this study was to evaluate patterns of care and overall survival after diagnosis of brain metastases in patients managed with ICI as component of care. Methods: Retrospective cohort study. Fifty patients were included (34 with brain metastases at first cancer diagnosis, 16 with metachronous spread). Results: Depending on symptoms, lesion number and size, and other individualized criteria, multidisciplinary tumor board (MDT) discussion resulted in highly individualized treatment sequences. Selected patients received systemic treatment alone. Twenty-four patients (48%) had any stereotactic radiosurgery (SRS) or neurosurgical resection at some point in time (upfront/salvage). Only 7 patients (14%) were never treated with brain irradiation or neurosurgery. Median overall survival (OS) was 13.0 months. Better Karnofsky performance status (KPS), absence of extracranial metastases, and time interval between cancer diagnosis and brain metastases of 0-18 months predicted for improved survival. Treatment sequence was not associated with survival. Patients without extracranial metastases had median OS of 52.2 months. Discussion/Conclusion: Long-term survival is possible in patients managed with ICI ± brain-directed treatment. This study did not identify a clear treatment sequence of choice. MDT assessment at diagnosis and each progression is recommended to ensure favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

et al. 2023

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“…Whole brain radiotherapy was the standard treatment for brain metastases until the last decade but causes cognitive decline in over 60% of patients within 2–6 months of treatment. It has now been replaced by stereotactic radiosurgery for fit patients with stable or controlled extracranial disease and a reasonable prognosis from their underlying cancer (at least 6 months) 19. Hippocampal sparing techniques are gaining in popularity for patients with brain metastases who are not suitable for treatment with stereotactic radiosurgery, but these techniques have not yet been shown to provide a consistent cognitive advantage…”

Section: Radiation Complications In the Brainmentioning

confidence: 99%

Radiation and the nervous system

Kosmin

Rees

2022

Pract Neurol

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Radiation therapy is widely used for benign and malignant brain tumours as it is effective and well tolerated. However, damage to the surrounding healthy nervous system tissue leads to a variety of complications both in the short term and long term, ranging from mild and self-limiting to irreversible and fatal. Radiation neurotoxicity is due to a combination of early inflammation and oligodendroglial damage followed later by brain tissue necrosis, white matter damage, accelerated vascular disease and the development of secondary tumours. This article explains the basic principles of radiation physics, the different modalities used in clinical practice, how radiotherapy is planned and delivered and the scientific basis of radiation damage. The main body of the article focuses on the clinical features of radiation toxicity in the brain, spinal cord, cranial and peripheral nerves with an emphasis on the distinction between early and delayed complications.

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“…Already before starting BrMs-specific treatment, a large percentage of patients experience cognitive problems; half of the patients demonstrate cognitive impairment on minimally one cognitive domain. [9][10][11][12] Multiple cognitive domains can be affected, with impairments reported in memory, executive function, and processing speed. However, substantial variability exists both within and between subjects in terms of cognitive domains of dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Different profiles of neurocognitive functioning in patients with brain metastases prior to brain radiotherapy

van Grinsven,

Cialdella,

Verhoeff

et al. 2023

Psycho-Oncology

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ObjectivePatients with brain metastases (BrMs) are a heterogeneous population, with almost 50% experiencing cognitive impairment before brain radiotherapy. Defining pre‐radiotherapy cognitive profiles will aid in understanding of the cognitive vulnerabilities and offer valuable insight and guidance for tailoring interventions.MethodsThe study population consisted of 58 adult patients with BrMs referred for radiotherapy. A semi‐structured interview and comprehensive battery including 10 neuropsychological tests were used to assess subjective and objective cognitive performance prior to radiotherapy.ResultsA majority (69%) of patients report decline in cognitive performance compared to their premorbid level (i.e. pre‐cancer). Objective testing revealed memory (52%), processing speed (33%) and emotion recognition (29%) deficits were most frequent. 21% of patients had no cognitive deficits while 55% had deficits (−1.5SD) in at least two cognitive domains. Hierarchical cluster analysis based on patient deficit profiles identified four clusters: (I) no or limited cognitive deficits selectively restricted to processing speed or executive function, (II) psychomotor speed deficits, (III) memory deficits and (IV) extensive cognitive deficits including memory. No patient or clinical‐related (e.g. age, number of BrMs, previous treatment) differences were found between clusters.ConclusionsPatterns of cognitive performance in patients with BrMs are heterogeneous, with most experiencing at least some degree of neurocognitive dysfunction. We identified four meaningful cognitive clusters. Stability of these clusters over time and in different samples should be assessed to advance understanding of the cognitive vulnerability of this patient population.

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The Impact of Stereotactic or Whole Brain Radiotherapy on Neurocognitive Functioning in Adult Patients with Brain Metastases: A Systematic Review and Meta-Analysis

Cited by 25 publications

References 73 publications

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

Patterns of Care and Survival in Cancer Patients with Brain Metastases Receiving Immune Checkpoint Inhibitors

Radiation and the nervous system

Different profiles of neurocognitive functioning in patients with brain metastases prior to brain radiotherapy

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