Prediction Models for Radiation-Induced Neurocognitive Decline in Adult Patients With Primary or Secondary Brain Tumors: A Systematic Review

Fariba Tohidinezhad, Dario Di Perri, Catharina M L Zegers, Jeanette Dijkstra, Monique Anten, Andre Dekker, Wouter Van Elmpt, Daniëlle B P Eekers, Alberto Traverso*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Purpose: Although an increasing body of literature suggests a relationship between brain irradiation and deterioration of neurocognitive function, it remains as the standard therapeutic and prophylactic modality in patients with brain tumors. This review was aimed to abstract and evaluate the prediction models for radiation-induced neurocognitive decline in patients with primary or secondary brain tumors.

Methods: MEDLINE was searched on October 31, 2021 for publications containing relevant truncation and MeSH terms related to "radiotherapy," "brain," "prediction model," and "neurocognitive impairments." Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool.

Results: Of 3,580 studies reviewed, 23 prediction models were identified. Age, tumor location, education level, baseline neurocognitive score, and radiation dose to the hippocampus were the most common predictors in the models. The Hopkins verbal learning (n = 7) and the trail making tests (n = 4) were the most frequent outcome assessment tools. All studies used regression (n = 14 linear, n = 8 logistic, and n = 4 Cox) as machine learning method. All models were judged to have a high risk of bias mainly due to issues in the analysis.

Conclusion: Existing models have limited quality and are at high risk of bias. Following recommendations are outlined in this review to improve future models: developing cognitive assessment instruments taking into account the peculiar traits of the different brain tumors and radiation modalities; adherence to model development and validation guidelines; careful choice of candidate predictors according to the literature and domain expert consensus; and considering radiation dose to brain substructures as they can provide important information on specific neurocognitive impairments.

Original languageEnglish
Article number853472
Number of pages10
JournalFrontiers in Psychology
Volume13
DOIs
Publication statusPublished - 31 Mar 2022

Keywords

  • CANCER
  • COGNITIVE FUNCTION
  • COMPLICATIONS
  • LOW-GRADE
  • METASTASES
  • PROPHYLACTIC CRANIAL IRRADIATION
  • QUALITY-OF-LIFE
  • RADIOTHERAPY
  • STEREOTACTIC RADIOSURGERY
  • THERAPY
  • artificial intelligence
  • cognitive dysfunction
  • cranial irradiation
  • machine learning
  • neurotoxicity

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