Neurocognitive outcomes in patients with brain metastases: a systematic review.

However, treatment-related neurocognitive sequelae remain a major challenge in survivorship.

然而，治疗相关的神经认知后遗症仍是幸存者面临的主要挑战。

Although advances in radiotherapy delivery techniques have reduced toxicity, the potential interaction with chemotherapy, targeted therapy, and immunotherapy, and the consequent effect on neurocognitive outcomes is poorly characterised.

尽管放射治疗的输送技术进步已经减少了毒性，但其与化疗、靶向治疗和免疫治疗的潜在相互作用，以及对神经认知结果的影响尚未得到充分描述。

We conducted a systematic reviewof clinical trials reporting neurocognitive endpoints in patients with brain metastases receiving radiotherapy with or without other concurrent systemic therapies.

我们进行了一项系统评价，回顾了报告接受放射治疗（有或无其他同时进行的全身治疗）的脑转移患者神经认知终点的临床试验。

Neurocognitive outcomes were manually extracted from published reports. 39 studies from 1997 to 2024 involving 6617 patients met inclusion criteria (n=27 whole-brain radiotherapy; n=12 radiosurgery), including six studies evaluating combined-modality therapy.

神经认知结果是手动从已发表的报告中提取的。从1997年到2024年的39项研究，涉及6617名患者符合纳入标准（n=27全脑放射治疗；n=12放射手术），包括六项评估联合治疗模式的治疗。

Baseline neurocognitive disability was frequently observed, and the majority of randomised trials evaluating advanced radiotherapy delivery techniques (hippocampal avoidance and radiosurgery) compared with whole-brain radiotherapy reported reduced cognitive decline and improved quality of life.

基线神经认知残疾经常被观察到，大多数评估高级放射治疗技术（海马回避和放射手术）与全脑放射治疗相比的随机试验报告了认知下降减少和生活质量改善。

There was no signal for increased toxicity with combined-modality therapy, including radiotherapy with concurrent systemic therapy, although evaluable trials were few in number.

尽管可评估的试验数量较少，但联合治疗模式，包括放疗与同时进行的系统治疗，并未显示出增加毒性的信号。

Given improvements in survival for patients with brain metastases, characterisation of long-term neurocognitive outcomes is growing in importance.

鉴于脑转移患者的生存率有所提高，长期神经认知结果的特征描述变得越来越重要。

There is an urgent need for targeted research to resolve evidence gaps around modality-specific neurocognitive toxicity and optimal sequencing of therapies.

迫切需要针对特定模式的神经认知毒性的研究，以解决证据空白，并确定治疗的最佳序列。

Systemic issues, such as integration of routine neuropsychological screening or assessment and incorporation of rehabilitation strategies into neuro-oncology care pathways, warrant evaluation.

需要评估系统性问题，例如将常规神经心理筛查或评估以及康复策略纳入神经肿瘤学护理路径的整合。

Exploration of emerging strategies, ranging from neuroprotectants to dose-sparing radiotherapy techniques, could further mitigate long-term adverse effects.

探索从神经保护剂到剂量节省放射治疗技术等一系列新兴策略，可能进一步减轻长期不良反应。