Neurocognitive Effects of Radiation Therapy in Brain Tumors

Radiation therapy remains a cornerstone in the management of primary and metastatic brain tumours, yet it carries the risk of lasting neurocognitive sequelae. Injury mechanisms include vascular endothelial damage, demyelination, neuroinflammation and direct neuronal loss, leading to measurable deficits in memory, attention, executive function and processing speed. Dose–volume relationships play a pivotal role: higher doses to critical structures such as the hippocampus, cingulate cortex or white matter tracts correlate with greater cognitive impairment. Advanced neuropsychological batteries and quantitative imaging modalities—diffusion tensor imaging (DTI), volumetric MRI and perfusion studies—now permit early detection of subtle microstructural changes. Patient factors such as age at treatment, tumour histology, concomitant chemotherapy and genetic susceptibility further modulate risk. Emerging strategies to mitigate neurocognitive decline include hippocampal-sparing techniques, proton therapy to reduce integral brain dose, reduced planning margins and multi-criteria optimisation in treatment planning. These approaches strive to preserve quality of life while maintaining tumour control, underscoring the global significance of balancing efficacy and late toxicity in radiotherapy for brain tumours.

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Neurocognitive Effects of Radiation Therapy in Brain Tumors publication trend

The graph below shows the total number of articles in neurocognitive effects of radiation therapy in brain tumors across all publications each year (not limited to Nature Index journals).

Technical terms

Neurocognitive decline: reduction in cognitive functions such as memory, attention and executive skills following exposure to radiation therapy.

Hippocampal-sparing radiotherapy: treatment planning approach that minimises radiation dose to the hippocampus to preserve memory function.

Dosimetric study: quantitative analysis of radiation dose distribution to organs at risk and target volumes.

Fractional anisotropy: diffusion tensor imaging metric reflecting the integrity of white matter pathways by measuring the directional coherence of water diffusion.

References

1. Predicting the risk of neurocognitive decline after brain irradiation in adult patients with a primary brain tumor. Neuro-Oncology (2024).
2. Dosimetric comparison of hippocampal-sparing technologies in patients with low-grade glioma. Neuro-Oncology Advances (2024).
3. Effect of radiation therapy on cerebral cortical thickness in glioma patients: Treatment-induced thinning of the healthy cortex. Neuro-Oncology Advances (2020).