Risk factors for neurocognitive decline in lung cancer patients treated with prophylactic cranial irradiation: A systematic review

Haiyan Zeng, Lizza E. L. Hendriks, Wouter H. van Geffen, Willem J. A. Witlox, Danielle B. P. Eekers, Dirk K. M. De Ruysscher*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

359 Downloads (Pure)


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.

Original languageEnglish
Article number102025
Number of pages17
JournalCancer Treatment Reviews
Publication statusPublished - Aug 2020


  • Lung cancer
  • Prophylactic cranial irradiation
  • Neurocognitive decline
  • Cognition impairment
  • Risk factor
  • RTOG 0212
  • EORTC 22003-08004


Dive into the research topics of 'Risk factors for neurocognitive decline in lung cancer patients treated with prophylactic cranial irradiation: A systematic review'. Together they form a unique fingerprint.

Cite this