Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 30:12:893264.
doi: 10.3389/fonc.2022.893264. eCollection 2022.

The Cognitive Effects of Radiotherapy for Brain Metastases

Eric J Lehrer  1 , Brianna M Jones  1 , Daniel R Dickstein  1 , Sheryl Green  1 , Isabelle M Germano  2 , Joshua D Palmer  3 , Nadia Laack  4 , Paul D Brown  4 , Vinai Gondi  5 , Jeffrey S Wefel  6 , Jason P Sheehan  7 , Daniel M Trifiletti  8
Affiliations
Review

The Cognitive Effects of Radiotherapy for Brain Metastases

Eric J Lehrer et al. Front Oncol. .

Abstract

Brain metastases are the most common intracranial neoplasm and are seen in upwards of 10-30% of patients with cancer. For decades, whole brain radiation therapy (WBRT) was the mainstay of treatment in these patients. While WBRT is associated with excellent rates of intracranial tumor control, studies have demonstrated a lack of survival benefit, and WBRT is associated with higher rates of cognitive deterioration and detrimental effects on quality of life. In recent years, strategies to mitigate this risk, such as the incorporation of memantine and hippocampal avoidance have been employed with improved results. Furthermore, stereotactic radiosurgery (SRS) has emerged as an appealing treatment option over the last decade in the management of brain metastases and is associated with superior cognitive preservation and quality of life when compared to WBRT. This review article evaluates the pathogenesis and impact of cranial irradiation on cognition in patients with brain metastases, as well as current and future risk mitigation techniques.

Keywords: brain metastases; cognition; neuro-oncology; neurosurgery; radiation oncology; radiation therapy; radiosurgery; whole brain radiation therapy.

PubMed Disclaimer

Conflict of interest statement

PB reports contribution to UpToDate outside of the submitted work. JW is on the advisory board of Bayer, he serves as a consultant to Angiochem, Bayer, Juno, Novocure, Vanquish Oncology, and GT Medical technologies. JP reports research funding and honoraria from Varian and research funding from Genentech, NIH, and Kroger; he serves on the advisory board of Novocure. IM serves as a consultant to BrainLab and Integra; DT reports institutional support from Novocure Ltd and consulting for Boston Scientific Corporation outside to the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Whole Brain Radiation Therapy Treatment Plan. Treatment plan for a 65-year-old woman with metastatic non-small cell lung cancer. She had a large burden of intracranial disease and was treated with WBRT to a dose of 30 Gy in 10 fractions. In WBRT, the entire brain including areas that play a major role in neurocognition receive the prescription radiation dose. The patient received memantine during and after treatment based on dosing from RTOG 0614. (Gy, gray; RTOG, radiation therapy oncology group; WBRT, whole brain radiation therapy). (B) Stereotactic Radiosurgery Treatment Plan. Treatment plan overlaid on simulation CT scan for a 50-year-old man with a history of BRAF wild-type metastatic melanoma who developed a left occipital lobe metastasis. He was treated with single fraction SRS to a dose of 20 Gy. (Gy, gray; SRS, stereotactic radiosurgery). (C) Whole Brain Radiation Therapy with Hippocampal Avoidance Treatment Plan. Treatment plan for a 60-year-old woman with metastatic breast cancer who was treated with HA-WBRT and memantine to 30 Gy in 10 fractions. Areas in red received the prescription dose, while areas in green and blue represent lower dose areas. Note the sparing of the bilateral hippocampi. (Gy, gray; HA-WBRT, hippocampal avoidance whole brain radiation therapy).
See this image and copyright information in PMC

References

    1. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence Proportions of Brain Metastases in Patients Diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol (2004) 22(14):2865–72. doi: 10.1200/JCO.2004.12.149 - DOI - PubMed
    1. Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LA, Eheman C, et al. . Annual Report to the Nation on the Status of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous System. J Natl Cancer Inst (2011) 103(9):714–36. doi: 10.1093/jnci/djr077 - DOI - PMC - PubMed
    1. Singh R, Stoltzfus KC, Chen H, Louie AV, Lehrer EJ, Horn SR, et al. . Epidemiology of Synchronous Brain Metastases. Neurooncol Adv (2020) 2(1):vdaa041. doi: 10.1093/noajnl/vdaa041 - DOI - PMC - PubMed
    1. Lehrer EJ, Stoltzfus KC, Jones BM, Gusani NJ, Walter V, Wang M, et al. . Trends in Diagnosis and Treatment of Metastatic Cancer in the United States. Am J Clin Oncol (2021) 44:572–9. doi: 10.1097/COC.0000000000000866 - DOI - PubMed
    1. Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Butowski N, et al. . Nccn Practice Guidelines in Oncology - Central Nervous System Cancers, Version 1.2017. J Natl Compr Cancer Netw (2017) 15:1331–45. doi: 10.6004/jnccn.2017.0166 - DOI - PubMed

LinkOut - more resources