Alliance N107C compared post-op SRS and whole brain radiation for patients with resected brain metastases. It found similar survival and less decline in cognitive function with SRS. This secondary analysis takes a look at cognitive outcomes among 54 patients (27 from each arm) who survived >1 year after treatment. After SRS, fewer patients had a >2 standard deviation decline in performance on at least 1 cognitive test at 3 months (22% v 70%), 6 months (19% v 46%), and 9 months (20% v 50%). As we can see from these rates, cognitive decline was rather quick from WBRT, but it persisted long-term. Quality of life outcomes were also better after SRS. The preservation of cognitive and QOL outcomes are important in the context of worse intracranial control at 12 months (40.7% v 81.5%). In other words, intracranial failure after SRS likely has little impact on cognition or QOL due to effective salvage treatment options. | Palmer, JAMA Oncol 2022


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