Neurocognitive function in patients with small cell lung cancer - Effect of prophylactic cranial irradiation
Neurocognitive function in patients with small cell lung cancer - Effect of prophylactic cranial irradiation
复制标题
DOI：
10.1002/cncr.23222
复制
发表时间：
2008-02-01
期刊：
影响因子：
6.2
通讯作者：
Komaki, Ritsuko
中科院分区：
文献类型：
--
作者：
Grosshans, David R.;Meyers, Christina A.;Komaki, Ritsuko
背景。由于担心对认知功能产生不利影响，小细胞肺癌（SCLC）患者预防性颅脑照射（PCI）的使用受到限制。在 PCI 之前和之后前瞻性地进行神经心理学测试，以评估其对 SCLC 患者认知功能的影响。方法。对初始治疗完全或部分有反应的 96 名患者在 PCI 前接受了正式的神经认知测试。排除三名患有中枢神经系统转移的患者。其余患者中，69 名接受 PCI（平均剂量，25 戈瑞 [Gy]，分 10 次）。对 37 名患者进行了重复测试（中位随访时间为 23 个月；范围为 6-120 个月）。 结果。基线损伤定义为低于标准平均值 >= 1.5 个标准差。在接受 PCI 之前，47% 的患者有认知功能受损的证据。 PCI 后，单变量分析显示执行功能（PCI 前平均值，15.6 +/- 11.5；PCI 后，27.1 +/- 17.6 [P =.0081]）和语言（PCI 前平均值，33.8 +/- 9.9；PCI 后，31.0 +/- 9.0 [P =.049]）在早期时间点出现显着短暂下降。控制非中枢神经系统疾病进展后，执行功能的缺陷不再显着。此外，这些缺陷并没有持续下去，并且语言和运动协调性得到了显着改善。多变量分析显示，PCI 前后没有发现显着差异。结论。 N神经认知测试表明，很大一部分 SCLC 患者在基线时脑功能受损。颅脑照射后未观察到认知功能持续下降。这些数据并不支持因担心神经毒性作用而省略 PCI。
BACKGROUND. The use of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC) has been tempered by fears of detrimental effects on cognitive function. Neuropsychologic testing was prospectively conducted before and after PCI to evaluate its effects on cognitive function in patients with SCLC.METHODS. Ninety-six patients who completely or partially responded to initial therapy underwent formal neurocognitive testing before PCI. Three patients who had central nervous system metastasis were excluded. Of the remaining patients, 69 received PCI (mean dose, 25 grays [Gy] in 10 fractions). Repeat testing was performed on 37 patients (median follow-up, 23 months; range, 6-120 months).RESULTS. Baseline impairment was defined as >= 1.5 standard deviations below the normative mean. Before undergoing PCI, 47% of patients had evidence of impaired cognitive function. After PCI, univariate analysis revealed significant transient declines in executive function (pre-PCI mean, 15.6 +/- 11.5; post-PCI, 27.1 +/- 17.6 [P =.0081) and language (pre-PCI mean, 33.8 +/- 9.9; post-PCI, 31.0 +/- 9.0 [P =.049]) at early timepoints. Controlling for noncentral nervous system disease progression the deficit in executive function was no longer significant. Moreover, these deficits were not sustained, and significant improvements in language and motor coordination were recorded. On multivariate analysis, no significant differences before and after PCI were found.CONCLUSIONS. NNeurocognitive testing demonstrated that a substantial portion of patients with SCLC had impaired brain functioning at baseline. Persistent declines in cognitive function were not observed after cranial irradiation. These data do not favor the omission of PCI on the basis of fears of neurotoxic effects.