Journal of Neuro-Oncology

, Volume 85, Issue 1, pp 77–79 | Cite as

Unexpected dementia following prophylactic cranial irradiation for small cell lung cancer: case report

  • David J. D’Ambrosio
  • Roger B. Cohen
  • Jon Glass
  • Andre Konski
  • Mark K. Buyyounouski
  • Steven J. Feigenberg
Clinical-Patient Studies



Prophylactic cranial irradiation (PCI) is commonly offered to patients with limited stage primary small cell lung cancer following a complete response.


We present the unique case of a 76-year-old woman treated with PCI with a dose of 30 Gy in 15 fractions, at 200 cGy per fraction who developed progressive dementia.


This is the first reported case of dementia from PCI at this low dose per fraction. Patients need to be counseled regarding the risks and benefits of treatment, including dementia with treatment and risk of sequelae from CNS metastasis without treatment. The authors review the data supporting PCI and the incidence of radiation associated dementia.


Brain Dementia Prophylactic Cranial Irradiation PCI Radiation Small cell lung cancer 


  1. 1.
    Auperin A, Arriagada R, Pignon JP, Le Pechoux C, Gregor A, Stephens RJ, Kristjansen PE, Johnson BE, Ueoka H, Wagner H, Aisner J (1999) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 341:476–484PubMedCrossRefGoogle Scholar
  2. 2.
    Catane R, Schwade JG, Yarr I, Lichter AS, Tepper JE, Dunnick NR, Brody L, Brereton HD, Cohen M, Glatstein E (1981) Follow-up neurological evaluation in patients with small cell lung carcinoma treated with prophylactic cranial irradiation and chemotherapy. Int J Radiat Oncol Biol Phys 7:105–109PubMedGoogle Scholar
  3. 3.
    Lee JS, Umsawasdi T, Lee YY, Barkley HT, Jr. Murphy WK, Welch S, Valdivieso M (1986) Neurotoxicity in long-term survivors of small cell lung cancer. Int J Radiat Oncol Biol Phys 12:313–321PubMedGoogle Scholar
  4. 4.
    Lishner M, Feld R, Payne DG, Sagman U, Sculier JP, Pringle JF, Yeoh JL, Evans WK, Shepherd FA, Maki E et al (1990) Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience. J Clin Oncol 8:215–221PubMedGoogle Scholar
  5. 5.
    Gregor A, Cull A, Stephens RJ, Kirkpatrick JA, Yarnold JR, Girling DJ, Macbeth FR, Stout R, Machin D (1997) Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: results of a multicentre randomised trial. United Kingdom Coordinating Committee for Cancer Research (UKCCCR) and the European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer 33:1752–1758PubMedCrossRefGoogle Scholar
  6. 6.
    Arriagada R, Le Chevalier T, Borie F, Riviere A, Chomy P, Monnet I, Tardivon A, Viader F, Tarayre M, Benhamou S (1995) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst 87:183–190PubMedCrossRefGoogle Scholar
  7. 7.
    Fleck JF, Einhorn LH, Lauer RC, Schultz SM, Miller ME (1990) Is prophylactic cranial irradiation indicated in small-cell lung cancer? J Clin Oncol 8:209–214PubMedGoogle Scholar
  8. 8.
    Kalemkerian GP (2007) NCCN Practice Guidelines Small Cell Lung Cancer v.1Google Scholar
  9. 9.
    Turrisi AT, 3rd Kim K, Blum R, Sause WT, Livingston RB, Komaki R, Wagner H, Aisner S, Johnson DH (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340:265–271PubMedCrossRefGoogle Scholar
  10. 10.
    DeAngelis LM, Delattre JY, Posner JB (1989) Radiation-induced dementia in patients cured of brain metastases. Neurology 39:789–796PubMedGoogle Scholar
  11. 11.
    Komaki R, Meyers CA, Shin DM, Garden AS, Byrne K, Nickens JA, Cox JD (1995) Evaluation of cognitive function in patients with limited small cell lung cancer prior to and shortly following prophylactic cranial irradiation. Int J Radiat Oncol Biol Phys 33:179–182PubMedCrossRefGoogle Scholar
  12. 12.
    Fonseca R, O’Neill BP, Foote RL, Grill JP, Sloan JA, Frytak S (1999) Cerebral toxicity in patients treated for small cell carcinoma of the lung. Mayo Clin Proc 74:461–465PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • David J. D’Ambrosio
    • 1
  • Roger B. Cohen
    • 2
  • Jon Glass
    • 3
  • Andre Konski
    • 1
  • Mark K. Buyyounouski
    • 1
  • Steven J. Feigenberg
    • 1
  1. 1.Department of Radiation OncologyFox Chase Cancer CenterPhiladelphiaUSA
  2. 2.Department of Medical OncologyFox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Department of NeurooncologyFox Chase Cancer CenterPhiladelphiaUSA

Personalised recommendations