[Brain metastases: Focal treatment (surgery and radiation therapy) and cognitive consequences].
Brain metastases represent the first cause of malignant brain tumor. Without radiation therapy, prognosis was poor with fast neurological deterioration, and a median overall survival of one month. Nowadays, therapeutic options depend on brain metastases presentation, extra brain disease, performance status and estimated prognostic (DS GPA). Therefore, for oligometastatic brain patients with a better prognosis, this therapeutic modality is controversial. In fact, whole-brain radiation therapy improves neurological outcomes, but it can also induce late neuro-cognitive sequelae for long-term survivors of brain metastases. Thus, in this strategy for preserving good cognitive functions, stereotactic radiation therapy is a promising treatment. Delivering precisely targeted radiation in few high-doses in one to four brain metastases, allows to reduce radiation damage to normal tissues and it should allow to decrease radiation-induced cognitive decline. In this paper, we will discuss about therapeutic strategies (radiation therapy and surgery) with their neuro-cognitive consequences for brain metastases patients and future concerning preservation of cognitive functions.
CHU de Poitiers, oncologie-radiothérapie, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: emmanuelle.reygagne@chu-poitiers.fr.
Emmanuelle
E
Reygagne
CHU de Poitiers, neurologie, 2, rue de la Milétrie, 86000 Poitiers, France.
Foucaud
F
Du Boisgueheneuc
CHU de Poitiers, oncologie-radiothérapie, 2, rue de la Milétrie, 86000 Poitiers, France.
Antoine
A
Berger
D001921:Brain / Q000528:radiation effects; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D003071:Cognition / Q000528:radiation effects*; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D019583:Dose Fractionation, Radiation; D006801:Humans; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis
Brain metastases; Cognitive impairment; Métastases cérébrales; Radiation therapy; Radiothérapie cérébrale; Stereotactic; Stéréotaxie; Toxicité cognitive