Aims: We search the literature on data regarding the role of whole-brain radiation therapy on neurocognitive functions, hearing, and alopecia, through the use of hippocampal-, scalp-, and cochlea-sparing radiotherapy (RT). Methods: Prospective and retrospective studies with at least five patients were included in this analysis, following PRISMA recommendations. Results: Eighteen works were selected for hippocampal sparing, published between 2015 and 2025 with 1736 patients. Neurocognitive functions were evaluated with a heterogeneous range of tests (mainly HVLT-R, TMT-A and TMT-B, Cowa test, and MME). For scalp-sparing RT, only three papers were selected, published between 2014 and 2015, for a total of 65 patients. There was an important heterogeneity in terms of scalp definitions, CTV prescriptions, used techniques and doses, and methods and scales adopted to evaluate the clinical efficacy of scalp-sparing RT. Regarding cochlea-sparing RT, no citation was selected. A meta-analysis could only be performed for the papers focusing on hippocampal-sparing procedures. Only nine papers meet the criteria, showing a high heterogeneity (chi-square = 229.96, df 8, p < 0.001, with the I2 index (96.52%) and the H2M index (27.75)). For this reason, we opted for random effect models DerSimonian Laird, maximum likelihood, and profile likelihood, which provided widely overlapping results. Although the data show an average protective effect of hippocampal avoidance on cognitive performance, the meta-analysis, based on the available studies, is unable to demonstrate its significance. Conclusions: A high heterogeneity in terms of hippocampal-, cochlear-, and scalp-sparing RT was registered as well as different and difficult to compare data. Our findings indicate the need for further studies to explore this issue.
Di Franco, R., Pezzulla, D., Chiesa, S., Cellini, F., Rocchi, E., Peluso, S., et al. (2025). Impact of whole-brain radiation therapy on neurocognitive functions, alopecia and hearing loss: a systematic review and meta-analysis endorsed by the Palliative Care and Neuro-Oncology Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). LA RADIOLOGIA MEDICA, -, --- [10.1007/s11547-025-02143-3].
Impact of whole-brain radiation therapy on neurocognitive functions, alopecia and hearing loss: a systematic review and meta-analysis endorsed by the Palliative Care and Neuro-Oncology Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)
Rocchi, Ettore;Peluso, Sara;
2025
Abstract
Aims: We search the literature on data regarding the role of whole-brain radiation therapy on neurocognitive functions, hearing, and alopecia, through the use of hippocampal-, scalp-, and cochlea-sparing radiotherapy (RT). Methods: Prospective and retrospective studies with at least five patients were included in this analysis, following PRISMA recommendations. Results: Eighteen works were selected for hippocampal sparing, published between 2015 and 2025 with 1736 patients. Neurocognitive functions were evaluated with a heterogeneous range of tests (mainly HVLT-R, TMT-A and TMT-B, Cowa test, and MME). For scalp-sparing RT, only three papers were selected, published between 2014 and 2015, for a total of 65 patients. There was an important heterogeneity in terms of scalp definitions, CTV prescriptions, used techniques and doses, and methods and scales adopted to evaluate the clinical efficacy of scalp-sparing RT. Regarding cochlea-sparing RT, no citation was selected. A meta-analysis could only be performed for the papers focusing on hippocampal-sparing procedures. Only nine papers meet the criteria, showing a high heterogeneity (chi-square = 229.96, df 8, p < 0.001, with the I2 index (96.52%) and the H2M index (27.75)). For this reason, we opted for random effect models DerSimonian Laird, maximum likelihood, and profile likelihood, which provided widely overlapping results. Although the data show an average protective effect of hippocampal avoidance on cognitive performance, the meta-analysis, based on the available studies, is unable to demonstrate its significance. Conclusions: A high heterogeneity in terms of hippocampal-, cochlear-, and scalp-sparing RT was registered as well as different and difficult to compare data. Our findings indicate the need for further studies to explore this issue.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
