Role of prophylactic brain irradiation in limited stage small cell lung cancer: clinical, neuropsychologic, and CT sequelae
Ninety-four patients with limited stage small cell lung cancer treated between 1981 and 1985 with a regimen including prophylactic brain irradiation (PBI) after combination chemotherapy were assessed for compliance with PBI, brain relapse, and neurologic morbidity. Seventy-seven percent of patients had PBI and of these, 22% developed brain metastases after a median time of 11 months post treatment. The brain was the apparent unique initial site of relapse in 10% of PBI cases but more commonly brain relapse was preceded or accompanied by failure at other sites, especially the chest. Brain metastases were the greatest cause of morbidity in 50% of PBI failures. Twelve of 14 PBI patients alive 2 years after treatment had oncologic, neurologic, and neuropsychological evaluation, and brain CT. All long-term survivors were capable of self care and none fulfilled diagnostic criteria for dementia, with three borderline cases. One third had pretreatment neurologic dysfunction and two thirds post treatment neurologic symptoms, most commonly recent memory loss. Fifty percent had subtle motor findings. Intellectual functioning was at the 38th percentile with most patients having an unskilled occupational history. Neuropsychologic impairment ratings were borderline in three cases and definitely impaired in seven cases. CT scans showed brain atrophy in all cases with mild progression in those having a pre-treatment baseline. Periventricular and subcortical low density lesions identical to the CT appearance of subcortical arteriosclerotic encephalopathy were seen in 82% of posttreatment CT studies, and lacunar infarcts in 54%. Neuropsychologic impairment scores and the extent of CT periventricular low density lesions were strongly associated.
- Research Organization:
- Cancer Control Agency of B.C. (Canada)
- OSTI ID:
- 6908256
- Journal Information:
- Int. J. Radiat. Oncol., Biol. Phys.; (United States), Vol. 14:6
- Country of Publication:
- United States
- Language:
- English
Similar Records
Magnetic resonance imaging in the evaluation of treatment-related central nervous system damage
Neuropsychological sequelae of central nervous system prophylaxis in survivors of childhood acute lymphoblastic leukemia
Related Subjects
BRAIN
IRRADIATION
LUNGS
NEOPLASMS
METASTASES
RADIOINDUCTION
COMBINED THERAPY
NERVOUS SYSTEM DISEASES
RADIOTHERAPY
SIDE EFFECTS
ATROPHY
COMPUTERIZED TOMOGRAPHY
PATIENTS
BODY
CENTRAL NERVOUS SYSTEM
DIAGNOSTIC TECHNIQUES
DISEASES
MEDICINE
NERVOUS SYSTEM
NUCLEAR MEDICINE
ORGANS
PATHOLOGICAL CHANGES
RADIOLOGY
RESPIRATORY SYSTEM
THERAPY
TOMOGRAPHY
560151* - Radiation Effects on Animals- Man