TY - JOUR
T1 - Risk factors for neurocognitive decline in lung cancer patients treated with prophylactic cranial irradiation
T2 - A systematic review
AU - Zeng, Haiyan
AU - Hendriks, Lizza E. L.
AU - van Geffen, Wouter H.
AU - Witlox, Willem J. A.
AU - Eekers, Danielle B. P.
AU - De Ruysscher, Dirk K. M.
N1 - Funding Information:
This research was supported by the following grant: Scholarship of China Scholarship Council (Grant No.: CSC 201909370087). We sincerely thank Prof. Ben Slotman from Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands and Prof. Cecile Le Pechoux from Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France for their responses to inquiries about the trials. DDR, LH and HZ conceived this study. HZ and LH searched papers in Pubmed. HZ and WVG screening the papers from titles to full texts. HZ extracted the data and assessed the risk of bias, LH checked the screening, extraction and assessments. HZ analyzed the results, DDR and HZ supervised the whole process. HZ, LH and DDR draft the manuscript, WVG, WW and DE revised it.
Funding Information:
This research was supported by the following grant: Scholarship of China Scholarship Council (Grant No. : CSC 201909370087 ). We sincerely thank Prof. Ben Slotman from Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands and Prof. Cecile Le Pechoux from Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France for their responses to inquiries about the trials.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/8
Y1 - 2020/8
N2 - Background: Prophylactic cranial irradiation (PCI) reduces brain metastasis incidence in lung cancer, however with risk of neurocognitive decline. Nevertheless, risk factors for neurocognitive decline after PCI remain unclear.Methods: We systematically reviewed the PubMed database according to the PRISMA guideline. Inclusion criteria were: randomized clinical trials (RCTs) and observational/single arm trials evaluating PCI, including >= 20 patients, reporting neurocognitive test results for lung cancer. Primary aim: evaluate risk factors associated with neurocognitive decline after PCI.Results: Twenty records were eligible (8 different RCTs, 8 observational studies), including 3553 patients in total (858 NSCLC, 2695 SCLC) of which 73.6% received PCI. Incidence of mild/moderate cognitive decline after PCI varied from 8 to 89% (grading not always provided); for those without PCI, this was 3.4-42%. Interestingly, 23-95% had baseline cognitive impairment. Risk factors were often not reported. In one trial, both age (> 60 years) and higher PCI dose (36 Gy) including twice-daily PCI were associated with a higher risk of cognitive decline. In one trial, white matter abnormalities were more frequent in the concurrent or sandwiched PCI arm, but without significant neuropsychological differences. One trial identified hippocampal sparing PCI to limit the neurocognitive toxicities of PCI and another reported an association between hippocampal dose volume effects and memory decline. As neurocognition was a secondary endpoint in most RCTs, and was assessed by various instruments with often poor/moderate compliance, high-quality data is lacking.Conclusions: Age, PCI dose, regimen and timing might be associated with cognitive impairment after PCI in lung cancer patients, but high-quality data is lacking. Future PCI trials should collect and evaluate possible risk factors systematically.
AB - Background: Prophylactic cranial irradiation (PCI) reduces brain metastasis incidence in lung cancer, however with risk of neurocognitive decline. Nevertheless, risk factors for neurocognitive decline after PCI remain unclear.Methods: We systematically reviewed the PubMed database according to the PRISMA guideline. Inclusion criteria were: randomized clinical trials (RCTs) and observational/single arm trials evaluating PCI, including >= 20 patients, reporting neurocognitive test results for lung cancer. Primary aim: evaluate risk factors associated with neurocognitive decline after PCI.Results: Twenty records were eligible (8 different RCTs, 8 observational studies), including 3553 patients in total (858 NSCLC, 2695 SCLC) of which 73.6% received PCI. Incidence of mild/moderate cognitive decline after PCI varied from 8 to 89% (grading not always provided); for those without PCI, this was 3.4-42%. Interestingly, 23-95% had baseline cognitive impairment. Risk factors were often not reported. In one trial, both age (> 60 years) and higher PCI dose (36 Gy) including twice-daily PCI were associated with a higher risk of cognitive decline. In one trial, white matter abnormalities were more frequent in the concurrent or sandwiched PCI arm, but without significant neuropsychological differences. One trial identified hippocampal sparing PCI to limit the neurocognitive toxicities of PCI and another reported an association between hippocampal dose volume effects and memory decline. As neurocognition was a secondary endpoint in most RCTs, and was assessed by various instruments with often poor/moderate compliance, high-quality data is lacking.Conclusions: Age, PCI dose, regimen and timing might be associated with cognitive impairment after PCI in lung cancer patients, but high-quality data is lacking. Future PCI trials should collect and evaluate possible risk factors systematically.
KW - Lung cancer
KW - Prophylactic cranial irradiation
KW - Neurocognitive decline
KW - Cognition impairment
KW - Risk factor
KW - QUALITY-OF-LIFE
KW - WHOLE-BRAIN RADIOTHERAPY
KW - PHASE-III TRIAL
KW - RANDOMIZED CONTROLLED-TRIAL
KW - RADIATION-THERAPY
KW - RTOG 0212
KW - COGNITIVE DYSFUNCTION
KW - EORTC 22003-08004
KW - METASTASES
KW - ONCOLOGY
U2 - 10.1016/j.ctrv.2020.102025
DO - 10.1016/j.ctrv.2020.102025
M3 - (Systematic) Review article
C2 - 32512415
SN - 0305-7372
VL - 88
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
M1 - 102025
ER -