Decline in Tested and Self-Reported Cognitive Functioning After Prophylactic Cranial Irradiation for Lung Cancer: Pooled Secondary Analysis of Radiation Therapy Oncology Group Randomized Trials 0212 and 0214

作者：Gondi Vinai^*; Paulus Rebecca; Bruner Deborah W; Meyers Christina A; Gore Elizabeth M; Wolfson Aaron; Werner Wasik Maria; Sun Alexander Y; Choy Hak; Movsas Benjamin

来源：International Journal of Radiation Oncology, Biology, Physics, 2013, 86(4): 656-664.

DOI：10.1016/j.ijrobp.2013.02.033

Purpose: To assess the impact of prophylactic cranial irradiation (PCI) on self-reported cognitive functioning (SRCF), a functional scale on the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). %26lt;br%26gt;Methods and Materials: Radiation Therapy Oncology Group (RTOG) protocol 0214 randomized patients with locally advanced non-small cell lung cancer to PCI or observation; RTOG 0212 randomized patients with limited-disease small cell lung cancer to high- or standard-dose PCI. In both trials, Hopkins Verbal Learning Test (HVLT)-Recall and -Delayed Recall and SRCF were assessed at baseline (after locoregional therapy but before PCI or observation) and at 6 and 12 months. Patients developing brain relapse before follow-up evaluation were excluded. Decline was defined using the reliable change index method and correlated with receipt of PCI versus observation using logistic regression modeling. Fisher%26apos;s exact test correlated decline in SRCF with HVLT decline. %26lt;br%26gt;Results: Of the eligible patients pooled from RTOG 0212 and RTOG 0214, 410 (93%) receiving PCI and 173 (96%) undergoing observation completed baseline HVLT or EORTC QLQ-C30 testing and were included in this analysis. Prophylactic cranial irradiation was associated with a higher risk of decline in SRCF at 6 months (odds ratio 3.60, 95% confidence interval 2.34-6.37, P%26lt;.0001) and 12 months (odds ratio 3.44, 95% confidence interval 1.84-6.44, P%26lt;.0001). Decline on HVLT-Recall at 6 and 12 months was also associated with PCI (P = .002 and P = .002, respectively) but was not closely correlated with decline in SRCF at the same time points (P = .05 and P = .86, respectively). %26lt;br%26gt;Conclusions: In lung cancer patients who do not develop brain relapse, PCI is associated with decline in HVLT-tested and self-reported cognitive functioning. Decline in HVLT and decline in SRCF are not closely correlated, suggesting that they may represent distinct elements of the cognitive spectrum.

• 出版日期2013-7-15