Neurologic, computed cranial tomographic, and magnetic resonance imaging abnormalities in patients with small-cell lung cancer: further follow-up of 6- to 13-year survivors.

Abstract

To determine the subsequent evolution of neurologic, neuropsychologic, and intracranial anatomic findings in long-term survivors of small-cell cancer, we repeated an evaluation done 4 years previously in patients 6 to 13 years after treatment. Fifteen patients were reevaluated with a history and physical examination, mental status examination, neuropsychologic testing, computed cranial tomographic (CCT) scans, and magnetic resonance imaging (MRI). All but one was ambulatory and none were institutionalized. Thirteen of 15 had neurologic complaints, 10 of 15 had an abnormal neurologic examination, seven of 14 had an abnormal mental status examination, 12 of 14 had abnormal neuropsychologic testing, 12 of 15 had abnormal CCT scans, and seven of 15 had white-matter abnormalities on MRI scans. No dramatic decline in performance status, functional status, neurologic symptoms, or neurologic examination occurred in these patients with 4 years of additional follow-up. More patients showed a decline in mental status examinations and neuropsychologic testing than demonstrated improvement. Anatomic studies showed no dramatic changes in the CCT scans and MRI confirmed these findings. From these data we conclude that there is a slow decline in neuropsychologic function in some of the patients surviving more than 6 years from a diagnosis of small-cell lung cancer. The anatomic abnormalities documented by CCT scans and MRI are more frequent in patients with abnormal neuropsychologic function.

Prophylactic Cranial Irradiation in Small-Cell Lung Cancer

“…Crossen et al [18] conducted a wide-ranging review of neurological and neurocognitive adverse effects noted in patients after cranial irradiation in various settings: brain necrosis, seizures, or dementia reported sometimes after high-dose irradiation for primary gliomas, learning deficits in children receiving moderate dose cranial irradiation as treatment for ALL, an interaction between chemotherapy and radiation, and abnormalities in psychometric testing showing up more readily than positive findings on clinical examination. Johnson and coworkers studied long-term survivors of SCLC [19,20] finding a decline in neurocognitive function with some correlation with abnormalities on CT scan. Problems were more frequent when chemotherapy was given at the time of cranial Yang, Matthews 295 irradiation, or large radiation fraction size was employed.…”

The Factors Influencing the Utilization of Prophylactic Cranial Irradiation in Patients With Limited-Stage Small Cell Lung Cancer

“…Surgical patients lost to follow-up with unknown chemotherapy receipt 7 or patients who refused chemotherapy 6 were excluded. All remaining 264 patients received systemic therapy as part of their initial therapy.…”

“…Brain irradiation has been associated with gradual damage to white matter, as observed on imaging. 7,13 Preclinical studies suggest an association among late neurotoxicity, inflammation, and damage to neural progenitor cells in the hippocampus and subventricular zone. [14][15][16] A dose-volume histogram analysis of 2 prospective clinical trials demonstrated that radiation-induced neurotoxicity is predicted by radiation dose to specific regions of the brain, including the hippocampus, rather than dose to the whole brain.…”

The effect of tianeptine in the prevention of radiation-induced neurocognitive impairment

“…Such cognitive changes can occur both pediatric and adult patients and include progressive deficits in shortterm memory, spatial relations, visual motor processing, quantitative skills, and attention [2]. Neurocognitive dysfunction was reported to stabilize spontaneously or to progress over time [5,6]. In some cases, subcortical dementia might result which often is associated with gait disturbance and incontinence.…”