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

Abstract

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.

Keywords: Brain metastases; Cognition; Neurocognitive functioning; Stereotactic radiosurgery; Whole-brain radiotherapy.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2021 The Author(s). Published by S. Karger AG, Basel.

Figures

Fig. 1

PRISMA flow chart illustrating the systematic process conducted to identify the articles included in this review. 14 original datasets*. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig. 2

Bar charts illustrating the pooled incidence of declined cognitive performance compared to baseline on the different cognitive constructs at different time points (a) WBRT and (b) SRS. The error bars display the 95% CIs. The table below the chart displays the number of patients for whom these data were available. CIs, confidence intervals.