49 Cognitive Impact of SRS vs. WBRT: Systematic Review & Meta-analysis avoiding high dose radiation on hippocampi and adding synthetic metallotexaphyrin motexafin gadolinium or memantine to WBRT have shown encouraging, but mixed results.53,54,74–79 These strategies provide promising prospects for the future, but do require further research. CONCLUSION This review indicates that after treatment with WBRT, most patients show declined cognitive performance until at least eight months after treatment, after which those with a longer overall survival show stable cognitive performance. A proportion of SRS-treated patients first show a decline in cognitive performance, but the majority of the patients return to pre-treatment levels already five months after SRS and continue to display stable cognitive performance up until one year after SRS. It remains challenging to disentangle the effects of radiotherapy on cognitive functioning from the possible deleterious effects of systemic treatments, the effects of BMs themselves and patient’s psychological state. Nonetheless, this current review indicates that while the cognitive side-effects of SRS are transient, after WBRT patients can experience deterioration over a longer period of time. Thus, SRS will result in lowest risks for cognitive adverse side-effects in this already (cognitively) vulnerable patient population with limited survival. This information can be used in communicating risks to patients and aid in making educated (shared) treatment decisions towards maintaining optimal QoL. SUPPLEMENTARY MATERIALS 2
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