Ultrarapid high-dose course of prophylactic cranial irradiation in small-cell lung cancer

Evaluation of late neurologic morbidity in 16 long-term survivors

L. Tomio, M. Romano, G. Zanchin, C. Carollo, P. Amista, L. Loreggian, G. Saladini, F. Berti, M. Pignataro, A. Paccagnella, A. Favaretto, F. Rea, F. Calzavara

Research output: Contribution to journalArticle

Abstract

Despite the reduction in the incidence of brain metastases following prophylactic cranial irradiation (PCI) in patients with small-cell lung cancer (SCLC), the use of this modality is still controversial due to the lack of improvement in survival and the appearance of neurotoxicity in long-term survivors. Moreover, the optimum dose, fraction size, and timing are not known. From 1980 to 1988, 70 patients with limited stage SCLC underwent PCI after or during multimodality treatment of their primary tumor. Most of these patients (75.7%) received an unconventional ultrarapid high-dose course of 17 Gy in two fractions over 3 days. Long-term (range 60-138 months) survivors (n = 16) were invited to have a complete neurological evaluation including computed cranial tomography (CCT), 99mTc-HMPAO single photon emission computerized tomography (SPECT) scan, electroencephalography (EEG), magnetic resonance imaging (MRI), and neuropsychometry. Delayed neurologic complications or psychometric impairment was observed in 46% of patients. One or more abnormalities were detected by CCT in all patients, and the presence of neurologic complications seemed to correlate with periventricular and subcortical white matter changes. A strong correlation was found between CCT and SPECT periventricular white matter changes. Although the incidence of late neurologic toxicity following this rapid course of irradiation was high, clinical findings were less severe than expected, and all the patients were capable of self-care.

Original languageEnglish
Pages (from-to)84-90
Number of pages7
JournalAmerican Journal of Dermatopathology
Volume21
Issue number1
Publication statusPublished - 1999

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Cranial Irradiation
Small Cell Lung Carcinoma
Nervous System
Survivors
Morbidity
Tomography
Single-Photon Emission-Computed Tomography
Technetium Tc 99m Exametazime
Incidence
Self Care
Psychometrics
Electroencephalography
Magnetic Resonance Imaging
Neoplasm Metastasis
Survival
Brain
Neoplasms

Keywords

  • Chemotherapy
  • Neurotoxicity
  • Rapid course prophylactic cranial irradiation
  • Small-cell lung cancer

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Dermatology

Cite this

Ultrarapid high-dose course of prophylactic cranial irradiation in small-cell lung cancer : Evaluation of late neurologic morbidity in 16 long-term survivors. / Tomio, L.; Romano, M.; Zanchin, G.; Carollo, C.; Amista, P.; Loreggian, L.; Saladini, G.; Berti, F.; Pignataro, M.; Paccagnella, A.; Favaretto, A.; Rea, F.; Calzavara, F.

In: American Journal of Dermatopathology, Vol. 21, No. 1, 1999, p. 84-90.

Research output: Contribution to journalArticle

Tomio, L, Romano, M, Zanchin, G, Carollo, C, Amista, P, Loreggian, L, Saladini, G, Berti, F, Pignataro, M, Paccagnella, A, Favaretto, A, Rea, F & Calzavara, F 1999, 'Ultrarapid high-dose course of prophylactic cranial irradiation in small-cell lung cancer: Evaluation of late neurologic morbidity in 16 long-term survivors', American Journal of Dermatopathology, vol. 21, no. 1, pp. 84-90.
Tomio, L. ; Romano, M. ; Zanchin, G. ; Carollo, C. ; Amista, P. ; Loreggian, L. ; Saladini, G. ; Berti, F. ; Pignataro, M. ; Paccagnella, A. ; Favaretto, A. ; Rea, F. ; Calzavara, F. / Ultrarapid high-dose course of prophylactic cranial irradiation in small-cell lung cancer : Evaluation of late neurologic morbidity in 16 long-term survivors. In: American Journal of Dermatopathology. 1999 ; Vol. 21, No. 1. pp. 84-90.
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