Evaluation of cognitive function in patients with limited small cell lung cancer prior to and shortly following prophylactic cranial irradiation

Komaki, Ritsuko; Meyers, Christina A.; Shin, Dong M.; Garden, Adam S.; Byrne, Kevin; Nickens, Judy A.; Cox, James D.

doi:10.1016/0360-3016(95)00026-u

Cited by 200 publications

(100 citation statements)

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“…22 Around that time, other studies reported a measurable deficit in neurocognitive function before PCI, which did not worsen further after PCI. 23,24 From 1997, PCI was reinstated in the treatment protocol. During Period III, 50% (9 of 18) of eligible patients actually underwent PCI.…”

Section: Resultsmentioning

confidence: 99%

Detection of brain metastases from small cell lung cancer

Seute

Leffers

Velde

et al. 2008

Cancer

162

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BACKGROUNDThe aims of this study were to show 1) the effect of changing from computed tomography (CT) to magnetic resonance imaging (MRI) on the prevalence of detected brain metastases (BM) in patients with newly diagnosed small cell lung cancer (SCLC); 2) the difference in survival between patients with single and multiple BM; and 3) the effect of the change in patient labeling on eligibility for prophylactic brain irradiation.METHODSFrom 1980 to 2004, 481 consecutive patients with SCLC were enrolled. Brain imaging was routinely performed after diagnosis of SCLC. At the start of 1991, MRI replaced CT in almost all patients. All patients were regularly examined by a neurologist.RESULTSThe prevalence of detected BM was 10% in the CT era and 24% in the MRI era. In the CT era, all detected BM were symptomatic, whereas in the MRI era, 11% were asymptomatic. In both periods, patients labeled as single BM survived longer than those labeled as multiple BM. For patients labeled as single BM or multiple BM, survival was longer in the MRI era than in the CT era. The proportion of patients who were eligible for prophylactic cranial irradiation was lower in the MRI era.CONCLUSIONSThe estimated prevalence of BM increases when MRI is used instead of CT. Patients with a detected single BM survive longer than patients with multiple BM. The apparently increased survival in the MRI era can be attributed to the “Will Rogers phenomenon”. The use of MRI makes fewer patients eligible for prophylactic cranial irradiation. Cancer 2008. ©2008 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Detection of brain metastases from small cell lung cancer

Seute

Leffers

Velde

et al. 2008

Cancer

162

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“…Detailed data regarding the toxicity of PCI have been limited. Retrospective and prospective studies have shown deficits in baseline assessments after systemic therapy and before the administration of PCI [42,43,48], emphasizing the need for prospective evaluation. Studies that have prospectively assessed the cognitive impact of PCI have not shown significant impairment attributed to PCI [42,48,49].…”

Section: Prophylactic Cranial Irradiationmentioning

confidence: 99%

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

Stinchcombe

Gore

2010

The Oncologist

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In the U.S., the prevalence of small cell lung cancer (SCLC) is declining, probably reflecting the decreasing prevalence of tobacco use. However, a significant number of patients will receive a diagnosis of SCLC, and approximately 40% of patients with SCLC will have limited-stage (LS) disease, which is potentially curable with the combination of chemotherapy and radiation therapy. The standard therapy for LS-SCLC is concurrent chemoradiotherapy, and the 5-year survival rate observed in clinical trials is approximately 25%. The standard chemotherapy remains cisplatin and etoposide, but carboplatin is frequently used in patients who cannot tolerate or have a contraindication to cisplatin. Substantial improvements in survival have been made through improvements in radiation therapy. Concurrent chemoradiotherapy is the preferred therapy for patients who are appropriate candidates. The optimal timing of concurrent chemoradiotherapy is during the first or second cycle, based on data from meta-analyses. The optimal radiation schedule and dose remain topics of debate, but 1.5 Gy twice daily to a total of 45 Gy and 1.8 -2.0 Gy daily to a total dose of 60 -70 Gy are commonly used treatments. For patients who obtain a near complete or complete response, prophylactic cranial radiation reduces the incidence of brain metastases and improves overall survival. The ongoing Radiation Therapy Oncology Group and Cancer and Leukemia Group B and the European and Canadian phase III trials will investigate different radiation treatment paradigms for patients with LS-SCLC, and completion of these trials is critical.

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“…At long-term, potential neurocognitive toxicity of PCI is of great concern, since sequalae like severe memory loss, intellectual impairment or even dementia, ataxia, or seizures have been reported in retrospective studies with small size and questionable methodology. For example, neurocognitive assessments prior to chemotherapy and/or PCI are lacking despite the fact that almost 50% of SCLC patients have neurologic and neurocognitive impairments prior to onset of PCI (Arriagada, 1995;Grosshans, 2008;Komaki, 1995). Neurocognitive impairment risk has been reported to strongly associate with daily fraction sizes of >3 Gy (Paumier & A Le Péchoux, 2010).…”

Section: Treatment Related Toxicitymentioning

confidence: 99%