Emerging Role of Neurocognitive Sparing Radiotherapy: Can it be the NewStandard of Care?

Whole-brain radiation therapy has been the standard form of treatment for advanced cancers, metastatic to the brain. It has the advantage of easy availability and delivery, and effectiveness in offering relief from symptoms for many suitable patients. Since most of these patients have poor outcomes and limited survival, oncologists in the past had a nihilistic approach and as a result, the potential toxicities emerging from WBRT have been largely neglected. With advances been made in neurosurgery, imaging, medical and radiation oncology, the results for many patients have improved significantly, particularly for those having favorable prognostic factors. Hence, the use of WBRT has come under scrutiny, due to its potential effect on the neurocognitive functions of the patient and their quality of life. This review article attempts to investigate if the various Neurocognitive sparing radiotherapy procedures can become a standard radiotherapy method for selected patients receiving whole brain radiotherapy for metastatic disease.