212 Chapter 9 Development in cancer healthcare has progressed immensely in the last decades, leading to improved survival rates and earlier detection of brain metastases (BMs).1–3 Consequently, the growing population of patients with BMs now survives longer after treatment. This has prompted an increased focus on psychosocial outcomes associated with cancer and cancer treatments. While stereotactic radiosurgery (SRS) is an effective treatment for BMs, there is currently insufficient understanding of its effects on the adjacent healthy brain tissue and resulting cognitive impairment of patients. This paucity of knowledge subsequently limits physicians in their ability to provide patients and their caregivers with clear expectation-management when confronted with the diagnosis and available treatment options. Therefore, the ultimate goal of research is to pinpoint, predict and eventually prevent treatmentrelated side-effects for optimal patient care. Patients with BMs inherently present a heterogeneous patient population with diverse medical histories. This calls for an individualized approach. Not only in healthcare management, but in research as well. With the advancements in modern medicine, including faster computers and advanced algorithms, it is now possible to tailor treatments to the specific needs of each patient. At the same time, this everevolving healthcare landscape necessitates a constant recalibration of research methodologies. To illustrate, at the outset of this research endeavor the most recent survival data for this patient group indicated a median survival of approximately 7 months.4,5 Interestingly, our observations within the COIMBRA cohort have unveiled a more intricate scenario, with median survival spanning between 12 and 33 months, depending upon the primary tumor type [SNO poster, data not shown]. This illustrates the dynamic nature of healthcare and the contextual backdrop against which our investigation unfolded. The purpose of this thesis was to set the initial steps towards investigating radiation-induced brain injury through a multidisciplinary approach, which involved the simultaneous exploration of neurocognitive functioning and potential MRI-biomarkers to provide an integrative and comprehensive view. Consequently, the forthcoming discussion will center on the convergent challenges, both patient and research-related, and the opportunities encountered over the course of this research (Figure 1).
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