SynthesisJournal of the National Cancer Institute2026
Redefining neurocognitive outcomes after radiation for brain metastases: a patient-level meta-analysis of recovery following initial decline.
Synthesis in Journal of the National Cancer Institute, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- RAPid simPLE (RAPPLE) Targeted Radiation Treatment Versus Whole Brain Radiation Therapy: A Retrospective Cohort Study of Matched Patients With Brain Metastases and Poor Prognosis.Advances in radiation oncology · 2026Article
- Application Mechanisms and Clinical Prospects of Brain-Computer Interface Technology in Radiation-Induced Brain Injury.Cellular and molecular neurobiology · 2026Review
- Water-soluble fullerene derivatives mitigate cranial radiation-induced neuroinflammation and cognitive dysfunction.Biomedical microdevices · 2026Article
- Brain Metastases From Differentiated Thyroid Cancer in the Era of Targeted Therapies: A Multi-Center Retrospective Cohort.Head & neck · 2026Article
- Patterns and predictors of cognitive function and post-traumatic growth in cancer patients: a latent profile analysis.Frontiers in psychiatry · 2026Article
- An initial report of memory avoidance whole brain radiotherapy to treat brain metastases.Neuro-oncology advancesArticle
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Authors and funding
9 authors.
Funding
Abstract
backgroundAlthough there are data describing the onset of neurocognitive toxicity following radiation for patients with brain metastases, less is known about the potential for functional cognitive recovery (CR). This study sought to evaluate CR following neurocognitive function failure (NCF) in patients treated with stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT), and hippocampal avoidance (HA)-WBRT.
methodsA pooled analysis of 3 (NCCTG N107C/CEC.3, NCCTG N0574, and NRG CC001) clinical trials was performed. Patients with trial-defined NCF and longitudinal cognitive testing were included. The primary endpoint was time to CR, defined as patients no longer exhibiting a 1 or more standard deviation decline from baseline on any cognitive test.
resultsA total of 288 patients were included, with a median follow-up of 12.2 months. The cumulative incidence of CR was 38% (95% confidence interval [CI] = 32.5% to 43.9%) at 6 months after NCF. Incidence of CR was significantly improved with post-op SRS vs WBRT (hazard ratio [HR] = 2.68, 95% CI = 1.43 to 5.03, P = .002) and with SRS vs SRS+WBRT (HR = 2.35, 95% CI = 1.16 to 4.79, P = .008). On multivariable analysis, SRS was highly prognostic of CR compared with WBRT (HR = 2.42, 95% CI = 1.70 to 3.45, P < .0001). Meta-analysis demonstrated that conformal RT techniques (SRS or HA-WBRT) conferred a significantly higher rate of CR compared with WBRT (pooled HR = 2.12, 95% CI = 1.49 to 3.02, P < .001); 68% of patients had long-term sustained CR.
conclusionsA sizeable proportion of patients who experience NCF following brain radiation eventually attain full and sustained CR, thereby highlighting that neurocognitive decline may not be permanent. The use of conformal radiation techniques results in greater rates of neurocognitive recovery.
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