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

Vinai Gondi, Rebecca Paulus, Deborah W. Bruner, Christina A. Meyers, Elizabeth M. Gore, Aaron Wolfson, Maria Werner-Wasik, Alexander Y. Sun, Hak Choy, Benjamin Movsas

Research output: Contribution to journalArticle

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Abstract

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). 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's exact test correlated decline in SRCF with HVLT decline. 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<.0001) and 12 months (odds ratio 3.44, 95% confidence interval 1.84-6.44, P<.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). 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.

Original languageEnglish (US)
Pages (from-to)656-664
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume86
Issue number4
DOIs
StatePublished - Jul 15 2013

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Cranial Irradiation
Radiation Oncology
lungs
Verbal Learning
radiation therapy
Lung Neoplasms
Radiotherapy
cancer
learning
irradiation
Observation
brain
confidence
Odds Ratio
Confidence Intervals
intervals
Recurrence
Small Cell Lung Carcinoma
logistics
Brain

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

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. / 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.

In: International Journal of Radiation Oncology Biology Physics, Vol. 86, No. 4, 15.07.2013, p. 656-664.

Research output: Contribution to journalArticle

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. / 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. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 86, No. 4. pp. 656-664.
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abstract = "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). 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's exact test correlated decline in SRCF with HVLT decline. 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<.0001) and 12 months (odds ratio 3.44, 95{\%} confidence interval 1.84-6.44, P<.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). 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.",
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AU - Gondi, Vinai

AU - Paulus, Rebecca

AU - Bruner, Deborah W.

AU - Meyers, Christina A.

AU - Gore, Elizabeth M.

AU - Wolfson, Aaron

AU - Werner-Wasik, Maria

AU - Sun, Alexander Y.

AU - Choy, Hak

AU - Movsas, Benjamin

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N2 - 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). 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's exact test correlated decline in SRCF with HVLT decline. 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<.0001) and 12 months (odds ratio 3.44, 95% confidence interval 1.84-6.44, P<.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). 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.

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