Agm. Vanoosterhout et al., SEQUELAE IN LONG-TERM SURVIVORS OF SMALL-CELL LUNG-CANCER, International journal of radiation oncology, biology, physics, 34(5), 1996, pp. 1037-1044
Citations number
41
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: Central nervous system (CNS) effects of chemotherapy and prop
hylactic cranial irradiation (PCI) are studied in long-term small cell
lung cancer (SCLC) survivors. The exact significance and pathogenesis
of the neurotoxicity is still unknown, as studies on this subject lac
k sufficient patient numbers and are performed in an extremely varied
manner. Methods and Materials: Fifty-nine survivors (> 2 years from di
agnosis) were examined neurologically and neuropsychologically, and un
derwent a cranial computed tomography (CT) scan or magnetic resonance
(MR). Eight patients were excluded from further analysis for various r
easons (not SCLC-related CNS disease, n = 6; no chemotherapy nor PCI t
reatment, n = 2). The remaining 51 patients were divided into three gr
oups; group 1 = chemotherapy alone (n = 21), group 2 = sequential PCI
(n = 19), and group 3 = concurrent or sandwiched PCI (n = 11). Groups
were neuropsychologically compared to matched controls. Results: Perfo
rmance status did not differ significantly between various treatment g
roups; all patients remained ambulatory and capable of self-care. Ment
al impairment (n = 20), motor abnormalities (n = 9), and visual compla
ints (n = 1), were found in five patients in group 1 (24%), eight pati
ents in group 2 (42%), and eight patients in group 3 (73%). Analysis o
f brain atrophy revealed no significant results; however, white matter
abnormalities were found more frequently in group 3. Neuropsychologic
ally no significant group differences existed, although interference s
ensitivity and difficulties with divided attention tended to occur mor
e frequently in patients treated with PCI. Mean neuropsychometric resu
lts of treatment groups were significantly worse than those of matched
controls. Conclusions: Although more intensively treated patients sho
wed more neurologic impairment and patients in group 3 had more white
matter abnormalities, there was no statistical evidence for additional
neurotoxicity of PCI. Marked neuropsychometric differences between pa
tients and matched controls may indicate that cognitive impairment is
partly disease related, probably due to emotional distress and deterio
rated physical condition.