Background amp; 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.
Oncol Res Treat

中文翻译：

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立体定向或全脑放疗对成年脑转移患者神经认知功能的影响：系统评价和荟萃分析

背景放大器; 目标：放射治疗是脑转移 (BM) 患者的标准治疗方法，尽管它可能会导致放射诱发的认知障碍。本综述探讨了全脑放疗 (WBRT) 或立体定向放射外科 (SRS) 对认知的影响。方法： PRISMA 指南用于确定 PubMed 和 EmBase 上关于未切除 BM 成年患者在放疗前和放疗后至少一次的客观认知评估的文章。结果：在筛选的 867 条记录中，包括了 20 篇文章（14 项独特的研究）。WBRT 导致认知能力下降，在存活至少 9-15 个月的患者中稳定或恢复到基线水平。对于 SRS，有时会在治疗后不久观察到认知能力下降，但大多数患者在治疗后一年才恢复或保持基线水平。结论：这些发现表明，在 WBRT 后，患者可能会在更长的时间内经历恶化。SRS 的认知副作用是短暂的。因此，本综述建议选择 SRS，因为这将导致认知不良副作用的风险最低，而与预测的生存期无关。在生存能力有限的认知脆弱患者群体中，该信息可用于传达风险并帮助做出明智的决定。
肿瘤资源治疗