2004 - Pattern Practice for Cognitive Preservation Strategies in Patients Receiving Whole-Brain Radiation Therapy: A Study from Middle Eastern Countries
Presenter(s)
R. Alhabib1, F. AlRowais2, I. Mohamad3, D. Al-Bukhari Jr4, S. Aljabab5,6, M. Aldehaim7, E. Eldebawy8, M. Alghamdi9, S. Owaidah2, F. Kaabi2, and I. Alotain2; 1King Fahad Specialist Hospital, Dammam, Saudi Arabia, 2Radiation Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia, 3Radiation Oncology, King Hussein Cancer Center, Amman, Jordan, 4Radiation Oncology, MNGH, Jeddah, Saudi Arabia, 5Radiation Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 6Radiation Oncology Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia, 7Radiation Oncology, King Faisal Specialist Hospital & Research Centr, Riyadh, Saudi Arabia, 8Radiation Oncology, National Cancer Institute Cairo University, Cairo, Egypt, 9College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
Purpose/Objective(s):
Whole-brain radiation therapy (WBRT) is a common palliative treatment for brain metastases (BM), though it is often associated with neurocognitive decline. Multiple studies have demonstrated that incorporating hippocampal avoidance (HA) and memantine into WBRT protocols can help preserve neurocognitive function. However, the adoption of these strategies as a standard of care in the Middle East remains unclear. The aim of this study was to characterize practice patterns related to neurocognitive preservation strategies used during WBRT.Materials/Methods:
An online survey was conducted to evaluate current practice patterns and identify barriers to the use of HA and memantine with WBRT across radiation oncology centers in the Middle East.Results:
A total of 124 radiation oncologists (ROs) from 45 centers across 15 countries completed the survey. Nearly half (49.2%) had over 10 years of experience, and most (87%) treated neuro-oncologic diseases. The largest group of respondents was from Saudi Arabia (41.9%), followed by Egypt (18.5%), with others from Jordan, United Arab Emirates., Tunisia, and additional Middle Eastern and North African countries.Only 3.2% routinely used both HA and memantine with WBRT; HA alone was used by 47.6%, and memantine alone by 27.4%. Approximately 48% reported treating over 50 patients with BM annually, and 68.5% offered WBRT to around 50 patients per year.Among ROs offering HA-WBRT, most (80.2%) prescribed it to fewer than half (1%–50%) of their WBRT patients. Common reasons for not offering HA-WBRT included concerns about missing disease (58.1%), resource-intensive treatment planning (53.2%), and treatment delays (41.9%).Among ROs offering memantine, over 90% prescribed it to fewer than half of their WBRT patients. Common reasons for not offering memantine included lack of experience with the drug (68.5%), insufficient evidence (47.6%), and reimbursement issues due to off-label use (45.5%).Reasons for not applying HA-WBRT included leptomeningeal disease (82.2%), poor performance status (80.6%), and small cell lung cancer histology (37.9%). ROs in private practice were more likely to offer HA-WBRT as a standard-of-care option compared with those practicing in university or public hospital settings (p < 0.05). Neither years of experience nor neuro-oncology specialization significantly influenced these practices.Conclusion:
Although WBRT is widely used in the Middle East, the integration of cognitive preservation strategies remains limited. Increased awareness and institutional support are needed to improve the adoption of HA and memantine in routine practice.