As treatments improve for cancer that has spread to the brain and patients live longer, understanding the long-term effect of these treatments on brain function is vital. Despite treatment advances, up to 90% of patients with brain metastases experience cognitive decline due to both their cancer and the long-term side effects of their treatments.
An international research group led by investigators in the Duke Center for Brain and Spine Metastasis evaluated how current cancer treatments like radiation therapy, systemic therapy, and surgery affect brain function and quality of life.
In a paper published in Lancet Oncology, the team reported neurocognitive outcomes from 39 clinical trials from 1997 to 2024 involving 6,617 patients. They found that advancements in radiotherapy delivery like radiosurgery and hippocampal avoidance whole brain radiotherapy have meaningfully reduced cognitive decline and improved quality of life.
However, the researchers are now pushing for change in future studies to address an important gap. Screening for cognitive decline and more formal neuropsychological testing were not included in many landmark trials for targeted therapies and immunotherapies.
“This limited our ability to draw definitive conclusions on the interaction of novel systemic therapies with radiotherapy and the consequent effect on neurocognition,” said Tarek Bou Dargham, MD, the paper’s first-author.
The paper concludes that strategies to mitigate the risk for cognitive decline like neuroprotectants, radioprotectants, and neurorehabilitation should also be further explored for patients with brain metastases.
“Data on the optimal sequencing of cancer therapies and their long-term effects has not kept up with the pace of discovery, said Eugene Vaios, MD, the paper’s senior author. “Our work provides a practical framework to bridge this evidence gap so we can deliver on our dual mandate to develop treatments that cure cancer and improve quality of life.”