TY - JOUR
T1 - The Impact of Stereotactic or Whole Brain Radiotherapy on Neurocognitive Functioning in Adult Patients with Brain Metastases
T2 - A Systematic Review and Meta-Analysis
AU - Van Grinsven, Eva Elisabeth
AU - Nagtegaal, Steven H.J.
AU - Verhoeff, Joost J.C.
AU - Van Zandvoort, Martine J.E.
N1 - Funding Information: At the time of writing this article, the first author received research funding from the Dutch Cancer Society “Koningin Wilhelmina Fonds (KWF)” Grant No. 11110. Publisher Copyright: © 2021 S. Karger AG. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background & Objectives: Radiotherapy is standard treatment for patients with brain metastases (BMs), although it may lead to radiation-induced cognitive impairment. This review explores the impact of whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) on cognition. Methods: The PRISMA guidelines were used to identify articles on PubMed and EmBase reporting on objective assessment of cognition before, and at least once after radiotherapy, in adult patients with nonresected BMs. Results: Of the 867 records screened, twenty articles (14 unique studies) were included. WBRT lead to decline in cognitive performance, which stabilized or returned to baseline in patients with survival of at least 9-15 months. For SRS, a decline in cognitive performance was sometimes observed shortly after treatment, but the majority of patients returned to or remained at baseline until a year after treatment. Conclusions: These findings suggest that after WBRT, patients can experience deterioration over a longer period of time. The cognitive side effects of SRS are transient. Therefore, this review advices to choose SRS as this will result in lowest risks for cognitive adverse side effects, irrespective of predicted survival. In an already cognitively vulnerable patient population with limited survival, this information can be used in communicating risks and aid in making educated decisions.
AB - Background & Objectives: Radiotherapy is standard treatment for patients with brain metastases (BMs), although it may lead to radiation-induced cognitive impairment. This review explores the impact of whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) on cognition. Methods: The PRISMA guidelines were used to identify articles on PubMed and EmBase reporting on objective assessment of cognition before, and at least once after radiotherapy, in adult patients with nonresected BMs. Results: Of the 867 records screened, twenty articles (14 unique studies) were included. WBRT lead to decline in cognitive performance, which stabilized or returned to baseline in patients with survival of at least 9-15 months. For SRS, a decline in cognitive performance was sometimes observed shortly after treatment, but the majority of patients returned to or remained at baseline until a year after treatment. Conclusions: These findings suggest that after WBRT, patients can experience deterioration over a longer period of time. The cognitive side effects of SRS are transient. Therefore, this review advices to choose SRS as this will result in lowest risks for cognitive adverse side effects, irrespective of predicted survival. In an already cognitively vulnerable patient population with limited survival, this information can be used in communicating risks and aid in making educated decisions.
KW - Brain metastases
KW - Cognition
KW - Neurocognitive functioning
KW - Stereotactic radiosurgery
KW - Whole-brain radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85118833252&partnerID=8YFLogxK
U2 - https://doi.org/10.1159/000518848
DO - https://doi.org/10.1159/000518848
M3 - Review article
C2 - 34482312
SN - 2296-5270
VL - 44
SP - 622
EP - 636
JO - ONCOLOGY RESEARCH AND TREATMENT
JF - ONCOLOGY RESEARCH AND TREATMENT
IS - 11
ER -