Brain morphology, survival and patient-reported outcomes after cranial radiotherapy

Abstract

Survival after cancer treatment is continuously improving due to new medication, surgery techniques and technological innovation. This forces us to consider long-term effects of treatment, that might be detrimental to a patient’s quality of life. One of these is cognitive decline after radiotherapy for brain tumours. In order to explain why this phenomenon occurs, I studied the effect of radiation dose to healthy brain tissue in part 1 of this thesis. This revealed that critical brain structures, such as the cortex or hippocampus, get smaller with increasing dose. This might mean that the currently used treatments might cause problems with important brain functions like memory and attention. Luckily, new innovations in radiotherapy can spare these brain regions to preserve cognitive function after treatment. My results can be used as a starting point to further study this. Part 2 focuses on survival and quality of life in patients with brain metastases. By gathering data on the current self-reported quality of life after radiotherapy, we get an overview of the effects our current treatments have. This is done in the COIMBRA study, which has an additional benefit of allowing us to test new treatments in so-called randomised trials. By comparing new innovations to the current standard in the COIMBRA study, we can quickly and reliably find out which treatments might improve quality of life in patients with brain metastases.