Vol 17, No 4 (2023)
Research paper
Published online: 2023-07-12

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The effect of hippocampal sparing during prophylactic cranial irradiation on the preservation of neurocognitive functions in patients with small cell lung cancer: a preliminary study

Karolina Loga1, Bartosz Wójcik2, Anna Stanisławek1, Anna Papis-Ubych3, Jacek Fijuth14, Leszek Gottwald14
Palliat Med Pract 2023;17(4):208-215.


Background: Prophylactic cerebral irradiation (PCI) is the standard of care for patients with limited small cell lung cancer (SCLC). Cerebral irradiation is associated with the deterioration of the quality of life in terms of cognitive function, in which the hippocampus plays a critical role. Protection of the hippocampus during PCI aims to reduce the adverse effects of ionizing radiation on neurocognitive function, which may be important for optimal quality of life. To date, subjective psychological tests have been used as a methodical assessment of cognitive function in patients after PCI.

Patients and methods: In 20 patients with SCLC, it was attempted to evaluate the effect of hippocampal sparing during PCI on the preservation of cognitive functions in these patients, using two diagnostic and screening tests: Mini-Mental State Examination (MMSE) Short Scale and Montreal Cognitive Assessment (MoCA) Scale. The assessment was made at three time points: before the start of radiation, immediately after completion of irradiation and 3 months after radiation therapy.

Results: The results indicate that after radiation therapy there is a deterioration in cognitive functions. Additionally, it was found that the results of both tests after radiation therapy differed significantly according to the gender and education of patients.

Conclusions: Following PCI, cognitive functions deteriorate in SCLC patients, even when radiation doses are reduced in the hippocampal area. This trend persists for at least 3 months after the end of brain irradiation.

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  1. Krzakowski M, Jassem J, Antczak A, et al. Thoracic neoplasms. Oncol Clin Pract. 2022; 18(1): 1–39.
  2. Krzakowski M, Orłowski T, Roszkowski K, et al. Drobnokomórkowy rak płuca – zalecenia diagnostyczno–terapeutyczne Polskiej Grupy Raka Płuca. For Med Rodz. 2008; 2(1): 56–64.
  3. Jassem J. [Systemic treatment of patients with non small cell lung cancer: from nihilism to hope]. Pneumonol Alergol Pol. 2014; 82(2): 79–81.
  4. Sher T, Dy GK, Adjei AA. Small cell lung cancer. Mayo Clin Proc. 2008; 83(3): 355–367.
  5. Blanchard P, Le Péchoux C. Prophylactic cranial irradiation in lung cancer. Curr Opin Oncol. 2010; 22(2): 94–101.
  6. Zhang W, Jiang W, Luan L, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer: a systematic review of the literature with meta-analysis. BMC Cancer. 2014; 14: 793.
  7. Owonikoko TK, Ramalingam S. Small cell lung cancer in elderly patients: a review. J Natl Compr Canc Netw. 2008; 6(3): 333–344.
  8. Chalubinska-Fendler J, Kepka L. Prophylactic cranial irradiation in non-small cell lung cancer: evidence and future development. J Thorac Dis. 2021; 13(5): 3279–3288.
  9. Modlińska A, Kowalczyk A. Lung cancer – epidemiology, clinical symptoms and social consequences. Psychoonkologia. 2016; 20(2): 57–65.
  10. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; 69(1): 7–34.
  11. Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends – an update. Cancer Epidemiol Biomarkers Prev. 2016; 25(1): 16–27.
  12. Kerwin Dr. How to prevent a delayed Alzheimer's diagnosis. J Fam Pract. 2009; 58(1): 9–15.
  13. Meyers CA, Smith JA, Bezjak A, et al. Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol. 2004; 22(1): 157–165.
  14. Regine WF, Schmitt FA, Scott CB, et al. Feasibility of neurocognitive outcome evaluations in patients with brain metastases in a multi-institutional cooperative group setting: results of Radiation Therapy Oncology Group trial BR-0018. Int J Radiat Oncol Biol Phys. 2004; 58(5): 1346–1352.
  15. Pospisil P, Kazda T, Bulik M, et al. Hippocampal proton MR spectroscopy as a novel approach in the assessment of radiation injury and the correlation to neurocognitive function impairment: initial experiences. Radiat Oncol. 2015; 10: 211–218.
  16. Tarnawski R, Michalecki L, Blamek S, et al. Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer. Neoplasma. 2011; 58(6): 507–515.
  17. Pękała M, Kozaka J. Quality of life of lung cancer patients. Psychoonkologia. 2016; 20(2): 90–97.
  18. Borland E, Nägga K, Nilsson PM, et al. The Montreal Cognitive Assessment: normative data from a large Swedish population-based cohort. J Alzheimers Dis. 2017; 59(3): 893–901.
  19. Wu Y, Zhang Yi, Yuan X, et al. Influence of education level on MMSE and MoCA scores of elderly inpatients. Appl Neuropsychol Adult. 2023; 30(4): 414–418.
  20. Rambe AS, Fitri FI. Correlation between the Montreal Cognitive Assessment-Indonesian Version (Moca-INA) and the Mini-Mental State Examination (MMSE) in Elderly. Open Access Maced J Med Sci. 2017; 5(7): 915–919.
  21. Jia X, Wang Z, Huang F, et al. A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study. BMC Psychiatry. 2021; 21(1): 485.
  22. Gondi V, Pugh SL, Tome WA, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol. 2014; 32(34): 3810–3816.
  23. Gondi V, Deshmukh S, Brown PD, et al. Sustained preservation of cognition and prevention of patient-reported symptoms with hippocampal avoidance during whole-brain radiotherapy for brain metastases: final results of NRG oncology CC001. Int J Radiat Oncol Biol Phys. 2023 [Epub ahead of print].
  24. Brown PD, Gondi V, Pugh S, et al. for NRG Oncology. Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: phase III trial NRG oncology CC001. J Clin Oncol. 2020; 38(10): 1019–1029.
  25. Redmond KJ, Hales RK, Anderson-Keightly H, et al. Prospective study of hippocampal-sparing prophylactic cranial irradiation in limited-stage small cell lung cancer. Int J Radiat Oncol Biol Phys. 2017; 98(3): 603–611.
  26. Gondi V, Deshmukh S, Brown PD, et al. Sustained preservation of cognition and prevention of patient-reported symptoms with hippocampal avoidance during whole-brain radiotherapy for brain metastases: final results of NRG oncology CC001. Int J Radiat Oncol Biol Phys. 2023 [Epub ahead of print].

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