[Cognition and radiation therapy for brain metastases: a new paradigm to define]

Whole-brain radiation therapy is suspected of early and late neurocognitive impairment in long-surviving patients with brain metastases. This putative whole-brain radiation therapy neurotoxicity leads to its postponing in brain metastases management, despite its well-established benefit in the brain control of the illness especially when associated with surgery or stereotactic radiosurgery. The incidence of neurocognitive impairment in patients with brain metastases and their link with tumoral progression or radiation during time are discussed in the light of recent randomized controlled trials. Therefore, we will address various options that are under investigation - despite poor data on pathophysiologic mechanisms - in an attempt to circumvent these side effects.