Neuroprotection in radiotherapy of brain metastases - a European pattern-of-care analysis by the ESTRO CNS Focus group.

BACKGROUND AND PURPOSE: Preservation of neurocognitive function is gaining importance for patients with brain metastases (BM). Several methods of neuroprotection in radiotherapy of BM have been developed and tested in prospective clinical trials, including stereotactic radiotherapy (SRT), hippocampal-sparing whole-brain radiotherapy (HS-WBRT) and concomitant memantine. The present analysis aimed to assess the current treatment patterns in European countries.

MATERIALS AND

METHODS

We distributed an online survey among radiation oncologists (ROs) registered within the European Society for Radiotherapy and Oncology (ESTRO). Questions included characteristics of treatment centers and institutional standard operating procedures, focusing on the use of neuroprotective measures.

RESULTS

The survey was completed by 234 ROs from 31 countries. WBRT is the preferred treatment modality over SRT for 4-5 BM for 18 % and for 6-10 BM for 53 % of ROs. While HS-WBRT is generally offered by most ROs (85 %), only a minority apply the technique regularly (25 %), and prescription parameters vary considerably. Concomitant memantine is prescribed by 30 % of ROs. Besides concerns about available evidence, limited staff capacity and reimbursement issues constitute frequent obstacles. Boost treatments as part of WBRT are rarely performed on a regular basis (22 %). Prognostic scores are used by a majority of ROs, while cognitive tests are not. There were significant differences between higher- and lower-income countries, and between university hospitals and other centers.

CONCLUSION

There is considerable heterogeneity regarding neuroprotective radiotherapy approaches in European countries and regular application is limited. Besides clinical trial results, improved technical availability and reimbursement might be required to improve their utilization for BM treatment.