title: Neurocognitive Effects Following Cranial Irradiation for Brain Metastases.
abstract: About 90% of patients with brain metastases have impaired neurocognitive function at diagnosis and up to two-thirds will show further declines within 2-6 months of whole brain radiotherapy. Distinguishing treatment effects from progressive disease can be challenging because the prognosis remains poor in many patients. Omitting whole brain radiotherapy after local therapy in good prognosis patients improves verbal memory at 4 months, but the effect of higher intracranial recurrence and salvage therapy rates on neurocognitive function beyond this time point is unknown. Hippocampal-sparing whole brain radiotherapy and postoperative stereotactic radiosurgery are investigational techniques intended to reduce toxicity. Here we describe the changes that can occur and review technological, pharmacological and practical approaches used to mitigate their effect in clinical practice.
authors.affiliation: Clinical Oncology, The University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK; School of Medicine, University of Queensland, Brisbane, Australia. Electronic address: Mark.pinkham@trinity.oxon.org.
authors.forename: M B
authors.initials: MB
authors.lastname: Pinkham
authors.affiliation: Hall Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sanghera
authors.affiliation: Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: G K
authors.initials: GK
authors.lastname: Wall
authors.affiliation: Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: B D
authors.initials: BD
authors.lastname: Dawson
authors.affiliation: Clinical Oncology, The University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Whitfield
mesh_terms: D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary; D003071:Cognition / Q000528:radiation effects*; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000209:etiology*; D011379:Prognosis; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology*
keywords: Brain metastases; hippocampus; neurocognitive function; quality of life; radiotherapy; stereotactic radiosurgery