Salman Afia, Naeem Unaiza, Ghazanfar Shamas, Jawed Areesha, Farooq Minaam
Dow University of Health Sciences, Karachi, Pakistan.
King Edward Medical University, Karachi, Pakistan.
Neurooncol Adv. 2025 May 30;7(1):vdaf073. doi: 10.1093/noajnl/vdaf073. eCollection 2025 Jan-Dec.
Whole-brain radiation therapy (WBRT) is used prophylactically and therapeutically in patients with brain metastases, effectively controlling intracerebral tumors and reducing neurological mortality. However, WBRT poses a significant risk of cognitive decline. Hippocampus-sparing WBRT (HS-WBRT) offers a potential solution by preserving memory and other cognitive functions. This study evaluates neurocognitive outcomes of HS-WBRT compared to WBRT in patients with brain metastases.
A systematic search was conducted in MEDLINE, Google Scholar, Embase, and CENTRAL for cohort studies and clinical trials reporting neurocognitive outcomes of HS-WBRT vs WBRT, up to March 2024. Non-English studies and those lacking neurocognitive outcomes were excluded. Eligible studies underwent data extraction and analysis focused on neurocognitive function testing.
Of 9 eligible studies, 7 were included in the quantitative analysis. HS-WBRT significantly reduced cognitive decline compared to WBRT, with improvements in Hopkins Verbal Learning Test (HVLT) scores for total recall (SMD = 0.42; = .02) and delayed recall (SMD = 0.25; = .02). Cognitive impairment measured by the Montreal Cognitive Assessment (MoCA) was also significantly lower in the HS-WBRT group (SMD = 1.21; < .00001).
HS-WBRT demonstrates a clear advantage over WBRT in preserving neurocognitive function in patients with brain metastases, as reflected in HVLT and MoCA scores. Future studies should further explore adverse effects and survival outcomes to guide clinical practice.
全脑放射治疗（WBRT）在脑转移瘤患者中用于预防性和治疗性目的，可有效控制脑内肿瘤并降低神经死亡率。然而，WBRT存在导致认知功能下降的重大风险。保留海马体的全脑放射治疗（HS-WBRT）通过保留记忆和其他认知功能提供了一种潜在的解决方案。本研究评估了脑转移瘤患者中HS-WBRT与WBRT相比的神经认知结果。
在MEDLINE、谷歌学术、Embase和CENTRAL中进行了系统检索，以查找截至2024年3月报告HS-WBRT与WBRT神经认知结果的队列研究和临床试验。排除非英文研究和缺乏神经认知结果的研究。对符合条件的研究进行数据提取和分析，重点是神经认知功能测试。
在9项符合条件的研究中，7项纳入了定量分析。与WBRT相比，HS-WBRT显著降低了认知功能下降，在霍普金斯言语学习测试（HVLT）总分回忆（标准化均值差[SMD]=0.42；P=.02）和延迟回忆（SMD=0.25；P=.02）方面有所改善。蒙特利尔认知评估（MoCA）测量的认知障碍在HS-WBRT组中也显著更低（SMD=1.21；P<.00001）。
如HVLT和MoCA评分所示，HS-WBRT在保留脑转移瘤患者神经认知功能方面比WBRT具有明显优势。未来的研究应进一步探索不良反应和生存结果，以指导临床实践。
