30 Chapter 2 of cognitive decline was absent in some manuscripts, the meta-analysis could only be performed for those studies that reported on this data. Table 1. Criteria for assessing the quality of the data of the manuscripts for the review, including reasons for assessing these criteria. Criteria Reason Inclusion of >20 patients at baseline (avoid type II errors for baseline data) ≥50% of patients available for first followup measurements (avoid type II errors for follow-up data) Neurocognitive performance scores corrected to norms for age, sex and education when appropriate (bias by demographical variables) Definition of change in cognitive performance was provided (bias by definition of change) Cognitive performance at follow-up time points were adjusted for baseline performance (bias by differences in baseline performance) Use of parallel versions of neuropsychological tests for retesting procedures was stated in the manuscript (bias by learning effects due to repeated administration) Diversity of neurocognitive assessment, assessed by fulfilling (1/2 point each): ≥3 different neuropsychological tests used AND ≥3 cognitive constructs assessed with test battery (quality of cognitive testing procedures) Baseline cognitive performance Data on baseline cognitive performance before WBRT was solely explicitly reported for the Mehta et al. study (N = 208).18 The other included studies reported relative scores to an unreported baseline. Before starting WBRT 91% of the patients displayed cognitive impairment (Z-score <1.5) on ≥1 neuropsychological test and 42% on ≥4 neuropsychological tests. Fine motor coordination was impaired in 6365%, learning and memory (L&M) in 21-60%, executive function (EF) in 44% and verbal fluency in 33%. Lower baseline cognitive performance correlated with higher total BMs volume at baseline, but not with number of BMs.18,25 On the contrary, in another study neither the volume of BMs nor volume of white matter injury correlated with L&M performance before radiotherapy in a subset of patients.26,27 Patients with a KPS of ≥80 and patients ≤65 years performed better at baseline on subtests of L&M.28
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