SEQUELAE IN LONG-TERM SURVIVORS OF SMALL-CELL LUNG-CANCER

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.