Neurocognitive outcome of HS-WBRT vs WBRT in patients with brain metastases: A systematic review and meta-analysis
Why this work is in the frame
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Bibliographic record
Abstract
Abstract Background Whole-brain radiation therapy (WBRT) is used prophylactically and therapeutically in patients with brain metastases, effectively controlling intracerebral tumors and reducing neurological mortality. However, WBRT poses a significant risk of cognitive decline. Hippocampus-sparing WBRT (HS-WBRT) offers a potential solution by preserving memory and other cognitive functions. This study evaluates neurocognitive outcomes of HS-WBRT compared to WBRT in patients with brain metastases. Methods A systematic search was conducted in MEDLINE, Google Scholar, Embase, and CENTRAL for cohort studies and clinical trials reporting neurocognitive outcomes of HS-WBRT vs WBRT, up to March 2024. Non-English studies and those lacking neurocognitive outcomes were excluded. Eligible studies underwent data extraction and analysis focused on neurocognitive function testing. Results Of 9 eligible studies, 7 were included in the quantitative analysis. HS-WBRT significantly reduced cognitive decline compared to WBRT, with improvements in Hopkins Verbal Learning Test (HVLT) scores for total recall (SMD = 0.42; P = .02) and delayed recall (SMD = 0.25; P = .02). Cognitive impairment measured by the Montreal Cognitive Assessment (MoCA) was also significantly lower in the HS-WBRT group (SMD = 1.21; P < .00001). Conclusion HS-WBRT demonstrates a clear advantage over WBRT in preserving neurocognitive function in patients with brain metastases, as reflected in HVLT and MoCA scores. Future studies should further explore adverse effects and survival outcomes to guide clinical practice.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it