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Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience
Lishner M, Feld R, Payne DG, Sagman U, Sculier JP, Pringle JF, Yeoh JL, Evans WK et al.. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1990-02-01
Topic: Brain proteins, microglia and lab models
We retrospectively analyzed the charts of 58 long-term survivors of small-cell lung cancer (SCLC) (greater than 2 years) for neurological complications and their impact on the well-being of these patients. We also attempted to have patients complete a questionnaire regarding any possible neurological problems. This was done in 14 patients. Metastasis to the CNS occurred significantly less often in patients who received prophylactic cranial irradiation (PCI) in a dose of 20 Gy in five equal fractions (two of 48), compared with patients who did not receive it (four of 10) (P less than .006). Delayed neurological complications occurred in nine of 48 (19%) patients who received PCI. However, in only two patients did PCI appear to be responsible for progressive dementia. In the other seven patients (one with weakness in the arms and legs, one with transient left hemiparesis, two with hearing loss, and three with various visual disturbances), chemotherapeutic agents (mainly cisplatin and vincristine) and underlying diseases probably contributed significantly to the occurrence of these complications. In addition, these neurological disturbances were transient or ran a stable course and did not adversely affect the daily life of these patients. In comparison, amongst the 10 patients who did not receive PCI one had progressive dementia and another had hemiparesis secondary to probable brain embolism. We conclude that the use of PCI in these doses was effective in reducing the frequency of CNS metastases and had an adverse effect on the daily life and well-being only in a minority of the patients. Until results of controlled randomized studies show otherwise, PCI should continue to be used as a part of the combined modality treatment of completely responding patients with limited SCLC.
Key findings
- Metastasis to the CNS occurred significantly less often in patients who received prophylactic cranial irradiation (PCI) in a dose of 20 Gy in five equal fractions (two of 48), compared with patients who did not receive it (four of 10) (P less than .006).
- In the other seven patients (one with weakness in the arms and legs, one with transient left hemiparesis, two with hearing loss, and three with various visual disturbances), chemotherapeutic agents (mainly cisplatin and vincristine) and underlying diseases probably contributed significantly to the occurrence of these complications.
- We conclude that the use of PCI in these doses was effective in reducing the frequency of CNS metastases and had an adverse effect on the daily life and well-being only in a minority of the patients.
- Until results of controlled randomized studies show otherwise, PCI should continue to be used as a part of the combined modality treatment of completely responding patients with limited SCLC.
Why it matters
This retrospective study of 58 long-term small-cell lung cancer survivors found that prophylactic cranial irradiation reduced CNS metastasis but that in only two patients did it appear responsible for progressive dementia. It concerns cancer treatment complications, not the treatment, cure, or prevention of Alzheimer's disease.
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Study details
- Participants14
- Evidence strengthHigh
How this study scored 44/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of clinical oncology : official journal of the American Society of Clinical Oncology) |
| Journal's citation record | 4 / 4 | Journal of Clinical Oncology: journal h-index 737 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1990 — older than 20 years, still counted |
| Sample size | 1 / 4 | 14 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 97 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.6 citations a year over 38 year(s) since 1990 |
| Impact for its field and year | 4 / 6 | Cited 11.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Ellen Maki: h-index 15 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Princess Margaret Cancer Centre: institution h-index 780 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 2153764) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 44 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Lishner, M., Feld, R., Payne, D. G., Sagman, U., Sculier, J. P., Pringle, J. F., et al. (1990). Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. https://doi.org/10.1200/jco.1990.8.2.215
Vancouver
Lishner M, Feld R, Payne DG, Sagman U, Sculier JP, Pringle JF, et al. Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 1990. doi:10.1200/jco.1990.8.2.215. PMID: 2153764.
BibTeX
@article{lishner1990-2153764,
author = {Lishner, M. and Feld, R. and Payne, D. G. and Sagman, U. and Sculier, J. P. and Pringle, J. F. and Yeoh, J. L. and Evans, W. K. and others},
title = {{Late neurological complications after prophylactic cranial irradiation in patients with small-cell lung cancer: the Toronto experience}},
journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
year = {1990},
doi = {10.1200/jco.1990.8.2.215},
pmid = {2153764},
url = {https://doi.org/10.1200/jco.1990.8.2.215}
}