BSBM-11 NEUROCOGNITIVE OUTCOMES OF HIPPOCAMPUS-SPARING WHOLE-BRAIN RADIATION THERAPY VERSUS WHOLE-BRAIN RADIATION THERAPY IN PATIENTS WITH BRAIN METASTASIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Abstract INTRODUCTION Whole brain radiation therapy (WBRT) is administered both prophylactically and therapeutically in patients with suspected and confirmed brain metastasis. Despite effective intracerebral tumor control and reduction in neurological mortality, WBRT is associated with a substantial risk of cognitive decline. Hippocampus-sparing WBRT (HS-WBRT) allows for the preservation of memory and other cognitive functions. We aimed to evaluate the neurocognitive outcomes of HS-WBRT in comparison with WBRT in patients with brain metastases. METHODS We searched MEDLINE (PubMed), Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for cohort studies and clinical trials reporting on HS-WBRT compared to WBRT for neurocognitive outcomes in brain metastasis patients, from inception to March 2024. Studies that were published in non-English language(s) and/or did not report neurocognitive outcomes of HS-WBRT compared with WBRT were excluded. Summary data of the eligible studies was extracted, which was analyzed for neurocognitive function testing. RESULTS Of the total nine studies, seven were included in the quantitative analysis. HS-WBRT led to a statistically significant reduction in cognitive decline as measured by the Hopkins Verbal Learning Test (HVLT) raw scores for total recall (TR) [SMD = 0.34 [0.16,0.53]; I2= 65%; p = 0.0003], and delayed recall (DR) [SMD = 0.26 [0.13,0.39]; I2= 62%; p = 0.0001]. Cognitive impairment, as measured by the Montreal Cognitive Assessment (MoCA), was also lower in the HS-WBRT group compared to the WBRT group [SMD = 0.82 [0.53,1.10]; I2= 88%; p < 0.00001]. CONCLUSION The findings of our study demonstrate that HS-WBRT confers a therapeutic advantage to WBRT in improving neurocognitive outcomes for patients with brain metastasis as measured by scores on HVLT-TR, HVLT-DR, and MoCA. Additional studies analyzing both treatment modalities’ adverse effects and mean survival time are imperative for informing future clinical recommendations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.035 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".