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Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
Cognitive and brain structural changes in a lung cancer population
Marta Simó1, James C Root, Lucía Vaquero
1*Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; †Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, L'Hospitalet del Llobregat, Barcelona, Spain; ‡Department of Psychiatry and Behavioral Sciences, Neurocognitive Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York, New York; §Radiation Oncology Department, Hospital Germans Trias i Pujol, ICO Badalona, Barcelona, Spain; Departments of ‖Radiation Oncology and ¶Medical Oncology, Lung Cancer Unit, ICO Duran i Reynals, L'Hospitalet del Llobregat, Barcelona, Spain; #Department of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; and **Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
Introduction:
No study has examined structural brain changes specifically associated with chemotherapy in a lung cancer population. The aim of this cross-sectional study was to assess differences in brain structure between small-cell lung cancer patients (C+) following chemotherapy, non-small-cell lung cancer patients (C-) before chemotherapy and healthy controls (HC).
Methods:
Twenty-eight small-cell lung cancer patients underwent a neuropsychological assessment and a structural magnetic resonance imaging, including T1-weighted and diffusion tensor imaging to examine gray matter density and white matter (WM) integrity, respectively, 1 month following completion of platinum-based chemotherapy. This group was compared with 20 age and education-matched non-small-cell lung cancer patients before receiving chemotherapy and 20 HC.
Results:
Both C+ and C- groups exhibited cognitive impairment compared with the HC group. The C+ group performed significantly worse than HC in verbal fluency and visuospatial subtests; C- performed significantly worse than both C+ and HC in verbal memory. Voxel-based morphometry analysis revealed lower gray matter density in the insula and parahippocampal gyrus bilaterally, and left anterior cingulate cortex in C+ compared with HC. Diffusion tensor imaging indices showed focal decreased WM integrity in left cingulum and bilateral inferior longitudinal fasciculus in the C+ group and more widespread decreased integrity in the C- group compared with the HC group.
Conclusion:
This study demonstrates that lung cancer patients exhibit cognitive impairment before and after chemotherapy. Before the treatment, C- showed verbal memory deficits as well as a widespread WM damage. Following treatment, the C+ group performed exhibited lower visuospatial and verbal fluency abilities, together with structural gray matter and WM differences in bilateral regions integrating the paralimbic system.
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