Johnson B E, Becker B, Goff W B, Petronas N, Krehbiel M A, Makuch R W, McKenna G, Glatstein E, Ihde D C
J Clin Oncol. 1985 Dec;3(12):1659-67. doi: 10.1200/JCO.1985.3.12.1659.
In order to evaluate the relationship between neurologic function and cranial irradiation, 20 patients treated on National Cancer Institute (NCI) small-cell lung cancer (SCLC) trials who were alive and free of cancer 2.4 to 10.6 years (median, 6.2) from the start of therapy were studied. All were tested with a neurologic history and examination, mental status examination, neuropsychologic testing, and review of serial computed cranial tomography (CCT) scans. Fifteen patients had been treated with prophylactic cranial irradiation (PCI), two patients with therapeutic cranial irradiation, and three received no cranial irradiation. All patients but one were ambulatory and none were institutionalized. Fifteen patients (75%) had neurologic complaints, 13 (65%) had abnormal neurologic examinations, 12 (60%) had abnormal mental status examinations, 13 (65%) had abnormal neuropsychologic testing, and 15 (75%) had abnormal CCT scans. Compared with those given low-dose maintenance chemotherapy during PCI using 200 to 300 rad per fraction, patients who were given high-dose induction chemotherapy during the time of cranial irradiation or large radiotherapy fractions (400 rad) were more likely to have abnormal mental status examinations (6/6 v 4/9) and abnormal neuropsychologic tests (6/6 v 4/9), but no major difference in CCT findings was present. CCT scans in the majority of cases (11/18) showed progressive ventricular dilatation or cerebral atrophy up to 8 years after stopping therapy. We conclude neurologic abnormalities are common in long-term survivors of SCLC, and may be more prominent in patients given high-dose chemotherapy during cranial irradiation or treated with large radiotherapy fractions. The CCT scan abnormalities are common and progressive years after prophylactic cranial irradiation and chemotherapy are stopped.
为了评估神经功能与颅脑照射之间的关系，我们对20例在国立癌症研究所（NCI）小细胞肺癌（SCLC）试验中接受治疗的患者进行了研究，这些患者自治疗开始后存活且无癌症，时间为2.4至10.6年（中位数为6.2年）。所有患者均接受了神经病史和检查、精神状态检查、神经心理学测试以及系列头颅计算机断层扫描（CCT）复查。15例患者接受了预防性颅脑照射（PCI），2例接受了治疗性颅脑照射，3例未接受颅脑照射。除1例患者外，所有患者均可行走，且均未住院。15例患者（75%）有神经方面的主诉，13例（65%）神经检查异常，12例（60%）精神状态检查异常，13例（65%）神经心理学测试异常，15例（75%）CCT扫描异常。与在PCI期间使用每次分割200至300拉德进行低剂量维持化疗的患者相比，在颅脑照射期间接受高剂量诱导化疗或大分割放疗（400拉德）的患者更有可能出现精神状态检查异常（6/6对4/9）和神经心理学测试异常（6/6对4/9），但CCT检查结果无重大差异。大多数病例（11/18）的CCT扫描显示，在停止治疗后长达8年的时间里，脑室逐渐扩大或脑萎缩。我们得出结论，神经异常在SCLC长期存活者中很常见，在颅脑照射期间接受高剂量化疗或接受大分割放疗的患者中可能更为突出。预防性颅脑照射和化疗停止多年后，CCT扫描异常很常见且呈进行性发展。
