title: 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: OBJECTIVE
  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.
  
  
  METHODS
  From 1999 to 2007, 50 patients with NSCLC treated with radical intent underwent PCI (30 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 (1)H 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 = 0.062). Visual-motor function deteriorated after treatment (p < 0.059). Performance IQ decreased (p < 0.025) and the difference between performance IQ and verbal IQ increased (p < 0.011). Degenerative periventricular vascular changes were observed in two patients. Analysis of the spectroscopic data showed metabolic but reversible alterations after PCI.
  
  
  CONCLUSIONS
  PCI in the current series was well tolerated and associated with a relatively low toxicity.
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Marzena
authors.initials: M
authors.lastname: Gawkowska-Suwińska
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Sławomir
authors.initials: S
authors.lastname: Blamek
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Heyda
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Boguszewicz
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Cichoń
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Zarudzki
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Nowicka
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Behrendt
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Smolska-Ciszewska
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Plewicki
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Zajusz
authors.affiliation: Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Tarnawski
keywords: MRS – 1H nuclear magnetic resonance spectra; Non-small cell lung cancer (NSCLC); Prophylactic cranial irradiation (PCI); Testosterone level; Toxicity of radiotherapy