Innovations in Whole Brain Radiation Therapy

Area of Science:

• Neuro-oncology
• Radiation oncology
• Neuroscience

Background:

• Whole brain radiation therapy (WBRT) is crucial for extensive brain metastases.
• Neurocognitive decline is a significant limitation of WBRT.
• The majority of patients experience impairment within a year of treatment.

Purpose of the Study:

• To review the clinical presentation and pathophysiology of radiation-induced neurocognitive impairment.
• To discuss established and emerging neuroprotective strategies.
• To explore methods for improving local tumor control and treatment efficiency.

Main Methods:

• Literature review of clinical presentations and underlying mechanisms of radiation-induced neurocognitive impairment.
• Examination of neuroprotective strategies, including pharmacological (memantine) and technical (hippocampal-avoidance, memory-avoidance, genu-sparing WBRT).
• Review of techniques for enhancing tumor control (simultaneous integrated boosts) and streamlining workflows (autosegmentation, simulation-free planning).

Main Results:

• Radiation-induced neurocognitive impairment is multifactorial, involving vascular injury, neuroinflammation, impaired neurogenesis, and white matter disruption.
• Established strategies like memantine and hippocampal-avoidance WBRT offer protection.
• Emerging techniques and workflow improvements aim to further preserve cognition and enhance treatment efficacy.

Conclusions:

• Balancing tumor control and neurocognitive preservation is critical, especially with improved survival for brain metastases patients.
• Advanced WBRT techniques and neuroprotective strategies are essential for managing long-term cognitive side effects.
• Optimizing treatment workflows can improve efficiency while maintaining focus on patient outcomes.