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 (SCLC, C+) following chemotherapy, non-small cell lung cancer patients (NSCLC, C-) prior to chemotherapy and healthy controls (HC).

MATERIAL AND METHODS

Twenty-eight SCLC underwent a neuropsychological assessment and a structural magnetic resonance imaging (MRI), including T1-weighted image-Voxel-based Morphometry (T1-VBM) and Diffusion Tensor Imaging (DTI) to examine gray matter density (GMD) and white matter (WM) integrity, respectively, one month following completion of platinum-based chemotherapy. This group was compared to 20 age and education-matched NSCLC patients prior to receive chemotherapy and 20 HC.

RESULTS

Both C+ and C- groups exhibited cognitive impairment compared to the HC group. 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. VBM analysis revealed lower GMD in the insula and parahippocampal gyrus bilaterally, and left anterior cingulate cortex in C+ compared to HC. DTI indices showed less focal WM integrity in left cingulum and bilateral ILF in C+ group and a widespread lower integrity, in C- group compared to HC.

CONCLUSION

This study demonstrates that lung cancer patients exhibit cognitive impairment prior to and following chemotherapy. Prior to treatment, C- showed verbal memory deficits as well as a widespread WM damage. Following treatment, C+ performed lower in visuospatial abilities and verbal fluency, together with structural GM and WM differences in bilateral regions integrating the paralimbic system.