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My chemobrain seems insignificant when compared to the side effects caused by whole brain radiation. Ironically, years of research into brain health helps me write a better post about whole brain radiation. I guess the issue here is cognitive decline now how the decline occurred.
I am a long-term cancer survivor. Living with long-term and late stage side effects compels me to research and write about cancer and its many related problems.
“Cognitive decline, particularly in memory, is a side effect seen in patients with brain metastases and when severe, can have a significant impact on their quality of life. It is most often the result of multiple intersecting etiologic factors, including the use of whole brain radiation therapy, effects of which, in part, are mediated by damage within the hippocampus. A variety of clinical factors and comorbidities may impact the likelihood and severity of this cognitive decline, and affected patients should be considered for evaluation in a comprehensive neuro-rehabilitation or “brain fitness” program…
Prevention strategies of neurocognitive decline due to whole brain radiotherapy (wbrt):
Avoiding WBRT is warranted for some patients with brain metastases; particularly those <50 years old. However, when WBRT is clinically indicated, hippocampal avoidance WBRT (HA-WBRT) has been shown to significantly reduce memory decline compared to historical controls without compromising treatment efficacy.
Additionally, the NMDA receptor antagonist memantine and renin-angiotensin-aldosterone system (RAAS) blockers have shown promise as neuroprotective agents that could be used prophylactically with radiation…
After the onset of neurocognitive decline the treatment is largely symptom-driven, however simply screening for and treating depression, fatigue, anxiety, cognitive slowing, and other processes may alleviate some impairment. Stimulants such as methylphenidate may be useful in treating symptoms of fatigue and cognitive slowing. Other treatments including donepezil and cognitive rehabilitation have been extensively tested in the population at risk for dementia, although they have not been adequately studied in patients following cranial radiotherapy. An innovative hypothetical approach is the use of intranasal metabolic stimulants such as low dose insulin, which could be valuable in improving cognition and memory, by reversing impaired brain metabolic activity.
Conclusions: Prevention of neurocognitive decline in patients with brain metastases requires a multimodal approach tailored to each patient’s need,
Likewise treatment will require a personalized combination of strategies optimized to address the patient’s symptoms.”
“Radiation-induced brain necrosis (RBN) is a serious complication of intracranial as well as skull base tumors after radiotherapy. In the past, due to the lack of effective treatment, radiation brain necrosis was considered to be progressive and irreversible. With better understanding in histopathology and neuroimaging, the occurrence and development of RBN have been gradually clarified, and new treatment methods are constantly emerging. In recent years, some scholars have tried to treat RBN with
bevacizumab,
nerve growth factor, and
gangliosides and have achieved similar results. Some cases of brain necrosis can be repairable and reversible. We aimed to summarize the incidence, pathogenesis, and treatment of RBN…
“Whole-brain radiation therapy (WBRT) is the treatment of last resort in the management of brain metastasis. Our duty to our patients is to cause the least harm possible balanced against the goals of therapy. This is a truism in any clinical scenario. When we are treating brain metastases, our clear first goal of treatment is to minimize the degree of neurologic injury that our patients experience. This injury can be from the brain metastasis itself or the treatment…