Gleim N, Turcas A, Minniti G, Grosu A L, Kazda T, Harat M, Fernandez S, Niyazi M, Nicolay N H, Seidel C
Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany; Comprehensive Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany.
Institute of Advanced Studies in Science and Technology (STAR-UBB), Babeș-Bolyai University, Cluj-Napoca, Romania; Radiotherapy Department, Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca, Romania.
Radiother Oncol. 2025 Aug;209:111000. doi: 10.1016/j.radonc.2025.111000. Epub 2025 Jun 21.
Preservation of neurocognitive function is gaining importance for patients with brain metastases (BM). Several methods of neuroprotection in radiotherapy of BM have been developed and tested in prospective clinical trials, including stereotactic radiotherapy (SRT), hippocampal-sparing whole-brain radiotherapy (HS-WBRT) and concomitant memantine. The present analysis aimed to assess the current treatment patterns in European countries.
We distributed an online survey among radiation oncologists (ROs) registered within the European Society for Radiotherapy and Oncology (ESTRO). Questions included characteristics of treatment centers and institutional standard operating procedures, focusing on the use of neuroprotective measures.
The survey was completed by 234 ROs from 31 countries. WBRT is the preferred treatment modality over SRT for 4-5 BM for 18 % and for 6-10 BM for 53 % of ROs. While HS-WBRT is generally offered by most ROs (85 %), only a minority apply the technique regularly (25 %), and prescription parameters vary considerably. Concomitant memantine is prescribed by 30 % of ROs. Besides concerns about available evidence, limited staff capacity and reimbursement issues constitute frequent obstacles. Boost treatments as part of WBRT are rarely performed on a regular basis (22 %). Prognostic scores are used by a majority of ROs, while cognitive tests are not. There were significant differences between higher- and lower-income countries, and between university hospitals and other centers.
There is considerable heterogeneity regarding neuroprotective radiotherapy approaches in European countries and regular application is limited. Besides clinical trial results, improved technical availability and reimbursement might be required to improve their utilization for BM treatment.
对于脑转移瘤（BM）患者而言，神经认知功能的保留正变得愈发重要。在BM放疗中，已经开发出多种神经保护方法，并在前瞻性临床试验中进行了测试，包括立体定向放疗（SRT）、海马体保留全脑放疗（HS-WBRT）以及联合使用美金刚。本分析旨在评估欧洲国家当前的治疗模式。
我们对在欧洲放射肿瘤学会（ESTRO）注册的放射肿瘤学家（RO）进行了一项在线调查。问题包括治疗中心的特征和机构标准操作程序，重点是神经保护措施的使用情况。
来自31个国家的234名RO完成了调查。对于4 - 5个BM，18%的RO认为WBRT比SRT更适合作为首选治疗方式；对于6 - 10个BM，53%的RO持此观点。虽然大多数RO（85%）通常会提供HS-WBRT，但只有少数人定期应用该技术（25%），并且处方参数差异很大。30%的RO会联合使用美金刚。除了对现有证据的担忧外，人员能力有限和报销问题是常见的障碍。作为WBRT一部分的强化治疗很少定期进行（22%）。大多数RO会使用预后评分，而认知测试则不然。高收入国家和低收入国家之间，以及大学医院和其他中心之间存在显著差异。
欧洲国家在神经保护放疗方法方面存在相当大的异质性，且常规应用有限。除了临床试验结果外，可能还需要提高技术可用性和报销水平，以改善其在BM治疗中的应用。
