Radiation-induced dementia in patients cured of brain metastases

Journal Article · Thu Jun 01 04:00:00 EDT 1989 · Neurology; (United States)

DOI:https://doi.org/10.1212/WNL.39.6.789· OSTI ID:5874705

DeAngelis, L M; Delattre, J Y; Posner, J B

When a patient with cancer develops a brain metastasis, death is usually imminent, but aggressive treatment in some patients with limited or no systemic disease yields long-term survival. In such patients, delayed deleterious effects of therapy are particularly tragic. We report 12 patients who developed delayed complications of whole brain radiotherapy (WBRT) given as sole treatment (4 patients) or in combination with surgical resection (8 patients). Within 5 to 36 months (median, 14) all patients developed progressive dementia, ataxia, and urinary incontinence causing severe disability in all and leading to death in 7. No patient had tumor recurrence when neurologic symptoms began. Cortical atrophy and hypodense white matter were identified by CT in all. Contrast-enhancing lesions were seen in 3 patients; 2 of the lesions yielded radionecrosis on biopsy. Autopsies on 2 patients revealed diffuse chronic edema of the hemispheric white matter in the absence of tumor recurrence. Corticosteroids and ventriculoperitoneal shunt offered significant but incomplete improvement in some patients. The total dose of WBRT was only 2,500 to 3,900 cGy, but daily fractions of 300 to 600 cGy were employed. We believe that these fractionation schedules, several of which are used commonly, predispose to delayed neurologic toxicity, and that more protracted schedules should be employed for the safe and efficacious treatment of good-risk patients with brain metastases. The incidence of WBRT-induced dementia was only 1.9 to 5.1% in the 2 populations reviewed here; however, this underestimates the incidence because only severely affected patients could be identified from chart review.

• Research Organization: Memorial Sloan-Kettering Cancer Center, New York, NY (USA)
• OSTI ID: 5874705
• Journal Information: Neurology; (United States), Journal Name: Neurology; (United States) Vol. 39:6; ISSN NEURA
• Country of Publication: United States
• Language: English

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560151* -- Radiation Effects on Animals-- Man
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
BIOLOGICAL EFFECTS
BIOLOGICAL MATERIALS
BIOLOGICAL RADIATION EFFECTS
BODY
BODY FLUIDS
BRAIN
CENTRAL NERVOUS SYSTEM
CEREBROSPINAL FLUID
DELAYED RADIATION EFFECTS
DISEASES
INJURIES
MALFORMATIONS
MATERIALS
MEDICINE
MENTAL DISORDERS
METASTASES
NEOPLASMS
NERVOUS SYSTEM
NUCLEAR MEDICINE
ORGANS
PATHOLOGICAL CHANGES
PATIENTS
RADIATION EFFECTS
RADIATION INJURIES
RADIOINDUCTION
RADIOLOGY
RADIOTHERAPY
SIDE EFFECTS
THERAPY