Van Oosterhout A G, Ganzevles P G, Wilmink J T, De Geus B W, Van Vonderen R G, Twijnstra A
Department of Neurology, University Hospital Maastricht, The Netherlands.
Int J Radiat Oncol Biol Phys. 1996 Mar 15;34(5):1037-44. doi: 10.1016/0360-3016(95)02257-0.
Central nervous system (CNS) effects of chemotherapy and prophylactic cranial irradiation (PCI) are studied in long-term small cell lung cancer (SCLC) survivors. The exact significance and pathogenesis of the neurotoxicity is still unknown, as studies on this subject lack sufficient patient numbers and are performed in an extremely varied manner.
Fifty-nine survivors (> 2 years from diagnosis) were examined neurologically and neuropsychologically, and underwent a cranial computer tomography (CT) scan or magnetic resonance (MR). Eight patients were excluded from further analysis for various reasons (not SCLC-related CNS disease, n = 6; no chemotherapy nor PCI treatment, n = 2). The remaining 51 patients were divided into three groups; group 1 = chemotherapy alone (n = 21), group 2 = sequential PCI (n = 19), and group 3 = concurrent or sandwiched PCI (n = 11). Groups were neuropsychologically compared in matched controls.
Performance status did not differ significantly between various treatment groups; all patients remained ambulatory and capable of self-care. Mental impairment (n = 20), motor abnormalities (n = 9), and visual complaints (n = 1), were found in five patients in group 1 (24%), eight patients in group 2 (42%), and eight patients in group 3 (73%). Analysis of brain atrophy revealed no significant results; however, white matter abnormalities were found more frequently in group 3. Neuropsychologically no significant group differences existed, although interference sensitivity and difficulties with divided attention tended to occur more frequently in patients treated with PCI. Mean neuropsychometric results of treatment groups were significantly worse than those of matched controls.
Although more intensively treated patients showed more neurologic impairment and patients in group 3 had more white matter abnormalities, there was no statistic evidence for additional neurotoxicity of PCI. Marked neuropsychometric differences between patients and matched controls may indicate that cognitive impairment is partly disease related, probably due to emotional distress and deteriorated physical condition.
对长期小细胞肺癌（SCLC）幸存者化疗及预防性颅脑照射（PCI）的中枢神经系统（CNS）影响进行研究。由于关于该主题的研究缺乏足够的患者数量且研究方式极为多样，神经毒性的确切意义及发病机制仍不明确。
对59名幸存者（诊断后超过2年）进行神经学和神经心理学检查，并进行头颅计算机断层扫描（CT）或磁共振成像（MR）。8名患者因各种原因被排除进一步分析（非SCLC相关的中枢神经系统疾病，n = 6；未接受化疗及PCI治疗，n = 2）。其余51名患者分为三组；第1组 = 单纯化疗（n = 21），第2组 = 序贯PCI（n = 19），第3组 = 同步或夹心PCI（n = 11）。对各治疗组与匹配对照组进行神经心理学比较。
各治疗组之间的体能状态无显著差异；所有患者均能行走且具备自理能力。第1组5名患者（24%）出现精神障碍（n = 20）、运动异常（n = 9）及视觉主诉（n = 1），第2组8名患者（42%），第3组8名患者（73%）。脑萎缩分析未得出显著结果；然而，第3组白质异常更为常见。神经心理学方面，各治疗组之间无显著差异，尽管PCI治疗患者的干扰敏感性及注意力分散困难更为常见。治疗组的平均神经心理测量结果显著差于匹配对照组。
尽管接受更强化治疗的患者显示出更多神经功能损害，且第3组患者有更多白质异常，但无统计学证据表明PCI存在额外的神经毒性。患者与匹配对照组之间明显的神经心理测量差异可能表明认知障碍部分与疾病相关，可能是由于情绪困扰和身体状况恶化所致。
