NEUROLOGICAL AND COGNITIVE IMPAIRMENT IN LONG-TERM SURVIVORS OF SMALL-CELL LUNG-CANCER

Despite its effectiveness in reducing the rate of brain metastases, th e role of prophylactic cranial irradiation (PCI) in the management of small cell lung cancer (SCLC) remains controversial because of concern about radiation-induced neurological morbidity. In order to evaluate morbidity and its impact on quality of life 64 patients surviving grea ter than or equal to 2 years in remission were recalled for assessment . 52 had received PCI. Most of the patients were well: 95% had perform ance status II and nine out of 37 neurological examinations were abnor mal. On neuropsychometric testing, only 19% of patients performed at t he level expected for their age and intellectual ability on all four t ests used. Fifty-four per cent of patients were impaired on two or mor e of the tests, suggesting a significant degree of measurable cognitiv e dysfunction. The number of patients who had not received PCI was ins ufficient for comparative analysis with the number who had, but among those treated with PCI, patients receiving 8 Gy in 1 fraction appeared less impaired than those receiving higher radiation doses in multiple fractions. The study showed that neuropsychometric testing is accepta ble to patients, can be administered by non-psychologists in the clini c and is sensitive to otherwise undetected deficits of cognitive funct ion in this patient population. Prospective evaluation of PCI should i nclude neuropsychometric testing.