81 Individual Cognitive Trajectories Post-Radiotherapy for Brain Metastases INTRODUCTION Brain metastases (BMs) represent a rapidly growing population currently encompassing 10-30% of the adult cancer population.1,2 This number is expected to increase due to earlier detection through enhanced imaging techniques and advancements in medical treatment improving survival rates. Overall survival rates currently range from months to several years.2–9 Treatment consists of different options, including radiotherapy, surgery, chemotherapy, immunotherapy or a combination.10 However, with prolonged survival comes the increased likelihood of experiencing cognitive side-effects from these treatments, underscoring the urgency of research into the impact of treatment on patients’ cognitive function. The ultimate goal of research is to enhance patient-centered care by providing wellinformed psycho-education. Prior to the start of treatment for BMs, a significant proportion of patients already experience cognitive difficulties; at least one out of every two patients demonstrates cognitive impairment on minimally one cognitive domain.11–14 Cancer treatment can lead to further deterioration of neurocognitive functioning with declines observed both after systemic therapy (i.e. chemo- and immunotherapy)15–18 and local therapies (i.e. brain radiotherapy). Multiple cognitive domains can be affected after brain radiotherapy with impairments reported in memory, executive function, and processing speed.11 On a group level, most patients exhibit a decline in neurocognitive performance during 8 months after whole-brain radiotherapy (WBRT), whereas after stereotactic radiosurgery (SRS), the majority of patients maintain a stable cognitive performance.11 However, substantial variety exists both within and between subjects in terms of which cognitive domains are affected and to what extent. Previous research indicated stable cognitive performance up to 9 months after SRS at group-level, while almost 40% showed declined performance on the individual level.19,20 Despite significant progress, many studies had limited follow-up durations and small sample sizes. Hence, it is crucial to confirm and continue to build upon previous findings. Therefore, the current study evaluated the individual trajectories of both subjective and objective cognitive performance in patients with BMs at the shortterm (i.e. 3 months) and at the long-term (i.e. ≥11 months) after radiotherapy. By using a reliable change index (RCI)21,22 we consider the test-retest reliability of neurocognitive tasks, enabling us to identify individual, clinically meaningful changes in cognitive functioning. This study aims to gain insights into the impact of treatment for BMs on patients’ lives by investigating individual cognitive functioning 4
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