Tolerability and toxicity of prophylactic cranial irradiation in patients with non-small cell lung cancer – Results of a phase II study (with estimation of hematological toxicity, pituitary function and magnetic resonance spectra changes)

Abstract

Aim

To evaluate the tolerability and toxicity of PCI in patients with NSCLC.

Background

Prophylactic cranial irradiation (PCI) is a standard treatment for patients with small cell lung cancer. There are data showing a decreasing ratio of brain metastases after PCI for non-small cell lung cancer (NSCLC-non small cell lung cancer) patients but, so far, there is no evidence for increasing overall survival. The main concern in this setting is the tolerance and toxicity of the treatment.

Materials and methods

From 1999 to 2007, 50 patients with NSCLC treated with radical intent underwent PCI (30[[ce:hsp sp="0.25"/]]Gy in 15 fractions). Mean follow-up was 2.8 years. The tolerability and hematological toxicity were evaluated in all patients, a part of participants had done neuropsychological tests, magnetic resonance imaging with ¹H nuclear magnetic resonance spectra, and estimation of pituitary function.

Results

During follow-up, 20 patients developed distant metastases, 4-brain metastases. Fourteen (30%) patients had acute side effects: (headache, nausea, erythema of the skin). The symptoms did not require treatment breaks. Six patients complained of late side effects (vertigo, nausea, anxiety, lower extremity weakness, deterioration of hearing and olfactory hyperesthesia). Hematological complications were not observed. Testosterone levels tended to decrease (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.062). Visual-motor function deteriorated after treatment (p[[ce:hsp sp="0.25"/]]<[[ce:hsp sp="0.25"/]]0.059). Performance IQ decreased (p[[ce:hsp sp="0.25"/]]<[[ce:hsp sp="0.25"/]]0.025) and the difference between performance IQ and verbal IQ increased (p[[ce:hsp sp="0.25"/]]<[[ce:hsp sp="0.25"/]]0.011). Degenerative periventricular vascular changes were observed in two patients. Analysis of the spectroscopic data showed metabolic but reversible alterations after PCI.

Conclusion

PCI in the current series was well tolerated and associated with a relatively low toxicity.