225 Discussion neurogenic niches, indeed exhibit different thresholds for radiation-induced brain damage. Figure 2. Illustration of how the brain reserve capacity could be buildup of multiple different factors. Depending on the change in all these different factors, the brain reserve capacity can be impacted. When it passes the threshold, these changes will lead to clinical expression (e.g. cognitive decline). FUTURE RECOMMENDATIONS While research in the BMs population is complicated by high attrition rates, especially at longer follow-up intervals, we have also learned that we cannot simply generalize results regarding brain-behavior associations from one population to another (Chapter 5). This stresses the importance of performing large-scale research in the BMs population itself. Ideally, multi-center or nationwide studies should be started to not only increase the number of patients, but also ensure to capture the diversity of patients with BMs. Throughout this discussion multiple avenues for future research have been mentioned. A summary of the most important points is listed below: • Use a transdiagnostic approach to incorporate a broad range of cognitive outcome measures throughout multiple different cohorts of cancer patients (e.g. lung and breast cancer) to be able to capture all patients with BMs 9
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