Self-reported practice patterns for cognitive preservation during whole-brain radiotherapy: a multinational cross-sectional survey of radiation oncologists in the Middle East and North Africa
8 affiliations
- 1Radiation Oncology Department, King Fahad Specialist Hospital
- 2Radiation Oncology Department, King Hussein Cancer Center
- 3Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto
- 4Radiation Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City
- 5Radiation Oncology Department, National Cancer Institute
- 6College of Medicine, King Saud Bin Abdulaziz University for Health Sciences
- 7Radiation Oncology Department, King Faisal Specialist Hospital and Research Centre
- 8Radiation Oncology Department, King Saud University
Abstract
Background: Whole-brain radiotherapy (WBRT) remains an important treatment for patients with diffuse brain metastases, but radiation-induced cognitive decline is a major concern. Hippocampal-avoidance WBRT (HA-WBRT) and memantine are recommended by international guidelines for eligible patients, yet the extent of their adoption across the Middle East and North Africa (MENA) region remains unclear.
Methods: A cross-sectional, anonymous questionnaire was distributed to radiation oncologists practising across the MENA region between January and March 2025 by email and professional social media. Because distribution was open, no sampling frame or response denominator could be defined, so the sample is a convenience sample. The instrument assessed self-reported practice patterns, availability and reported utilisation of HA-WBRT and memantine, perceived barriers, and follow-up and cognitive-assessment practices. All proportions are reported at the respondent level. Categorical comparisons used the chi-squared or Fisher’s exact test with exact p values and odds ratios; multivariable logistic regression with cluster-robust standard errors by centre was performed as an exploratory analysis. Reporting follows STROBE and CHERRIES.
Results: In total, 124 radiation oncologists from 45 centres across 15 countries responded. HA-WBRT was reported as being routinely offered to eligible patients by 60 respondents (48.4%) and memantine by 34 (27.4%); 28 (22.6%) reported offering both routinely and 58 (46.8%) neither. When asked what proportion of their WBRT patients actually received both interventions, 70 (56.5%) answered never and only 4 (3.2%) more than 50%. Memantine was reported as available in the respondent’s centre by 48 (38.7%), while 66 (53.2%) did not know whether it was approved for brain metastases. The most frequently endorsed barriers were concern about missing intracranial disease (72; 58.1%) for HA-WBRT and lack of experience with the drug (84; 67.7%) for memantine. Formal cognitive testing was infrequent: 90 respondents (72.6%) reported using no cognitive assessment tool.
Conclusion: Among the radiation oncologists who responded, self-reported routine use of cognitive-preservation strategies during WBRT was limited, with reported utilisation lower than reported offering. These findings describe the practices reported by a convenience sample and should not be interpreted as establishing the prevalence of underuse across the MENA region.
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BibTeX
@article{alhabib2026selfreported,
title = {{Self-reported practice patterns for cognitive preservation during whole-brain radiotherapy: a multinational cross-sectional survey of radiation oncologists in the Middle East and North Africa}},
author = {Renda AlHabib and Fahad AlRowais and Issa Mohamad and Ali Hosni and Douaa Albukhari and Eman Eldebawy and Fatimah Kaabi and Majed Alghamdi and Mohammed Aldehaim and Saif Aljabab and Sara Owaidah and Shakir Al-Shakir and Ibrahim Alotain},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1927397},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1927397/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Self-reported practice patterns for cognitive preservation during whole-brain radiotherapy: a multinational cross-sectional survey of radiation oncologists in the Middle East and North Africa
AU - Renda AlHabib
AU - Fahad AlRowais
AU - Issa Mohamad
AU - Ali Hosni
AU - Douaa Albukhari
AU - Eman Eldebawy
AU - Fatimah Kaabi
AU - Majed Alghamdi
AU - Mohammed Aldehaim
AU - Saif Aljabab
AU - Sara Owaidah
AU - Shakir Al-Shakir
AU - Ibrahim Alotain
PY - 2026
DA - 2026/10/13
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1927397
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1927397/full
AB - Background: Whole-brain radiotherapy (WBRT) remains an important treatment for patients with diffuse brain metastases, but radiation-induced cognitive decline is a major concern. Hippocampal-avoidance WBRT (HA-WBRT) and memantine are recommended by international guidelines for eligible patients, yet the extent of their adoption across the Middle East and North Africa (MENA) region remains unclear. Methods: A cross-sectional, anonymous questionnaire was distributed to radiation oncologists practising across the MENA region between January and March 2025 by email and professional social media. Because distribution was open, no sampling frame or response denominator could be defined, so the sample is a convenience sample. The instrument assessed self-reported practice patterns, availability and reported utilisation of HA-WBRT and memantine, perceived barriers, and follow-up and cognitive-assessment practices. All proportions are reported at the respondent level. Categorical comparisons used the chi-squared or Fisher’s exact test with exact p values and odds ratios; multivariable logistic regression with cluster-robust standard errors by centre was performed as an exploratory analysis. Reporting follows STROBE and CHERRIES. Results: In total, 124 radiation oncologists from 45 centres across 15 countries responded. HA-WBRT was reported as being routinely offered to eligible patients by 60 respondents (48.4%) and memantine by 34 (27.4%); 28 (22.6%) reported offering both routinely and 58 (46.8%) neither. When asked what proportion of their WBRT patients actually received both interventions, 70 (56.5%) answered never and only 4 (3.2%) more than 50%. Memantine was reported as available in the respondent’s centre by 48 (38.7%), while 66 (53.2%) did not know whether it was approved for brain metastases. The most frequently endorsed barriers were concern about missing intracranial disease (72; 58.1%) for HA-WBRT and lack of experience with the drug (84; 67.7%) for memantine. Formal cognitive testing was infrequent: 90 respondents (72.6%) reported using no cognitive assessment tool. Conclusion: Among the radiation oncologists who responded, self-reported routine use of cognitive-preservation strategies during WBRT was limited, with reported utilisation lower than reported offering. These findings describe the practices reported by a convenience sample and should not be interpreted as establishing the prevalence of underuse across the MENA region.
SN - 2234-943X
ER -