44 Chapter 2 Figure 2. Bar charts illustrating the pooled incidence of declined cognitive performance compared to baseline on the different cognitive constructs at different time points (a) WBRT and (b) SRS. The error bars display the 95% CIs. The table below the chart displays the number of patients for whom these data were available. Abbreviations: CIs, confidence intervals. DISCUSSION The aim of this study was to systematically assess the current evidence on the cognitive changes across different cognitive constructs after either WBRT or SRS in adult patients with non-resected BMs with objective neurocognitive assessments performed at baseline and after treatment. Our meta-analysis indicates that after WBRT the majority of patients show a decline in cognitive performance until midterm follow-up (5-8 months), whereas a subset of patients with relatively good outcome shows stable cognitive performance in the long-term (9-15 months). For SRS, an initial dip (1-4 months) in cognitive performance in patients was observed by half of the studies, whereas at mid- and long-term follow-up all studies reported that the majority of the patients performed at pre-treatment levels. Since cognitive decline was assessed relative to baseline performance, differences in cognitive performance prior to radiotherapy were accounted for and thus cannot explain the differences between WBRT and SRS. This suggests that while the cognitive sideeffects of SRS are transient, after WBRT patients can experience deterioration over a
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