Komaki R, Meyers C A, Shin D M, Garden A S, Byrne K, Nickens J A, Cox J D
Department of Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1995 Aug 30;33(1):179-82. doi: 10.1016/0360-3016(95)00026-U.
Cognitive deficits after treatment for small cell lung cancer (SCLC) have been attributed to prophylactic cranial irradiation (PCI). A prospective study of neuropsychological function was undertaken to document the evolution and magnitude of neuropsychologic deficits.
Thirty patients with limited stage SCLC who responded well (29 complete response (CR), 1 partial response (PR)) to combination chemotherapy plus thoracic irradiation or resection were studied with neuropsychological tests in the cognitive domains of intelligence, frontal lobe function, language, memory, visual-perception, and motor dexterity prior to a planned course of PCI. Nine patients had a neurologic history that could influence testing.
An unexpected 97% (29 out 30) of patients had evidence of cognitive dysfunction prior to PCI. The most frequent impairment was verbal memory, followed by frontal lobe dysfunction, and fine motor incoordination. Of the patients with no prior neurologic or substance abuse history, 20 out of 21 (95%) had impairments on neuropsychological assessment. This neurologically normal group was just as impaired as the group with such a history with respect to delayed verbal memory and frontal lobe executive function. Eleven patients had neuropsychological testing 6 to 20 months after PCI; no significant differences were found from their pretreatment tests.
A high proportion of neurologically normal patients was limited SCLC and favorable responses to combination chemotherapy have specific cognitive deficits before receiving PCI. Short-term (6 to 20 months) observations after PCI have shown no significant deterioration.
小细胞肺癌（SCLC）治疗后的认知缺陷被归因于预防性颅脑照射（PCI）。进行了一项神经心理学功能的前瞻性研究，以记录神经心理学缺陷的演变和程度。
对30例局限期SCLC患者进行研究，这些患者对联合化疗加胸部照射或手术切除反应良好（29例完全缓解（CR），1例部分缓解（PR））。在计划进行PCI之前，用神经心理学测试对患者在智力、额叶功能、语言、记忆、视觉感知和运动敏捷性等认知领域进行评估。9例患者有可能影响测试的神经病史。
在PCI之前，意外发现97%（30例中的29例）的患者有认知功能障碍的证据。最常见的损害是言语记忆，其次是额叶功能障碍和精细运动不协调。在没有既往神经病史或药物滥用史的患者中，21例中有20例（95%）在神经心理学评估中有损害。在延迟言语记忆和额叶执行功能方面，这个神经功能正常的组与有此类病史的组受损程度相同。11例患者在PCI后6至20个月进行了神经心理学测试；与治疗前测试相比未发现显著差异。
高比例神经功能正常的局限期SCLC患者在接受PCI之前，对联合化疗反应良好但存在特定的认知缺陷。PCI后的短期（6至20个月）观察显示无显著恶化。
