ESTRO 2025 - Abstract Book

S668

Clinical - CNS

ESTRO 2025

999

Digital Poster Neuroprotection in radiotherapy of brain metastases – a European pattern-of-care analysis by the ESTRO CNS Focus Group Nils Gleim 1,2 , Andrada Turcas 3 , Giuseppe Minniti 4 , Anca L. Grosu 5 , Tomas Kazda 6 , Maciej Harat 7,8 , Sharon Fernandez 9 , Maximilian Niyazi 10 , Nils H. Nicolay 1,2 , Clemens Seidel 1,2 1 Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany. 2 Partner Site Leipzig, Comprehensive Cancer Center Central Germany, Leipzig, Germany. 3 Department of Radiotherapy, Oncology Institute "Prof. Dr. Ion Chiricuta“, Cluj-Napoca, Romania. 4 Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy. 5 Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany. 6 Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic. 7 Department of Clinical Medicine, University of Science and Technology, Bydgoszcz, Poland. 8 Department of Neurooncology and Radiosurgery, Franciszek Lukaszczy Oncology Center, Bydgoszcz, Poland. 9 Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom. 10 Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany Purpose/Objective: Preservation of neurocognitive function gains importance for patients with brain metastases (BM), as an increasing number of patients survive in the long-term. Several methods for neuroprotection have been developed and tested in clinical trials, such as focal stereotactic radiotherapy (SRT), hippocampal-sparing whole-brain radiotherapy (HS WBRT) and concomitant memantine. However, the available evidence is reflected differently by guideline recommendations, and little is known on their influence on implementation in clinical practice. The present analysis aimed to analyze the current patterns of care in European countries. Material/Methods: We performed an online survey consisting of 34 questions, distributed among radiation oncologists (ROs) registered within the European Society of Radiation Oncology (ESTRO) from July to September 2024. Questions included characteristics of treatment centers as well as institutional standard operating procedures for BM treatment and follow-up, use of neurocognitive testing and prognostic scores, and the use of neuroprotective measures. Results: The survey was completed by 263 ROs, predominantly working in university hospitals (62%). WBRT is still preferred over SRT for 4-5 BM by 18% of ROs, for 6-10 BM by 53% of ROs. While HS-WBRT is generally offered by most ROs (85%), only a minority applies the technique regularly (25%), and applied prescription parameters vary considerably. Concomitant memantine is prescribed by 32% of ROs. Besides concerns about the available evidence, limited staff capacity and issues regarding reimbursement were given as obstacles hindering the implementation of neuroprotective methods. An integrated or sequential boost to BM as part of WBRT is rarely performed on a regular basis (20%). While a third of ROs do not use prognostic scores, the (ds-)GPA score has been reported as the most frequently used tool. A majority of ROs does not perform tests to assess cognition at baseline or over the course of treatment (62%). There was a considerable heterogeneity in the utilization of neuroprotective approaches between individual European countries. Conclusion: There is considerable heterogeneity regarding neuroprotective radiotherapy approaches for patients with BM in European countries. Improved technical availability and reimbursement, as well as uniform guideline recommendations might be required to improve the utilization of neuroprotective radiotherapy approaches for BM treatment.

Keywords: brain metastases, neuroprotection, pattern-of-care