SARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear.

This analysis of the complete data on the 2003 SARS epidemic in Hong Kong has revealed key epidemiologic features of the epidemic as it evolved.

This study demonstrated that longitudinal outcome trajectories following a major health-threat event in an Asian sample bear close resemblance to prototypical trajectories observed in trauma studies using Western samples. Unique predictors of the trajectories included factors observed in previous studies, such as social support, as well as factors of particular relevance to a major disease outbreak, such as SARS-related worry.

Radiotherapy for nasopharyngeal carcinoma seemed to have adverse but insignificant effects on the cognitive functions of the patients. However, for patients who developed temporal lobe necrosis after radiotherapy, memory, language, motor ability, and executive functions were significantly impaired, although their general intelligence remained relatively intact.

BACKGROUND Cognitive dysfunction is common in patients who develop radionecrosis after receiving radiotherapy for nasopharyngeal carcinoma (NPC). However, the impact of the location and volume of radionecrosis on cognitive dysfunction remains unclear. The authors found a significant association between the severity of cognitive impairment and the volume of radionecrosis; in turn, the volume of radionecrosis was affected by patient age at time radiotherapy was completed. METHODS Fifty patients with NPC who received radiotherapy were evaluated by a battery of neuropsychologic tests of cognitive function. The brain lesion volume was quantified, and the lesion locations were identified by standardized brain templates. The results of the neuropsychologic tests were correlated with lesion volume. Gender, education, age at the completion of radiotherapy, brain volume, total dose, and fractional dose were evaluated as risk factors for lesion volume. RESULTS Lesion volume was correlated significantly with the severity of cognitive deficits. Larger left‐hemisphere lesions were correlated with lower verbal memory (from P < 0.001 to P = 0.008) and language abilities (from P = 0.001 to P = 0.018), whereas larger right‐hemisphere lesions were associated with worse visual memory (from P = 0.009 to P = 0.039). Finally, patients who received radiotherapy at a younger age had smaller lesion volumes (P < 0.001). CONCLUSIONS The volume and location of radionecrosis had an influential impact on the pattern of cognitive impairment found in patients with NPC, and patient age at the time radiotherapy was completed appeared to affect the volume of radionecrosis found after radiotherapy. Cancer 2003;97:2019–26. © 2003 American Cancer Society. DOI 10.1002/cncr.11295

BACKGROUND Radiotherapy is an important treatment modality for brain tumors and is the standard radical treatment for nasopharyngeal carcinoma (NPC). However, the treatment is not free of side effects, and one possible neurologic sequela is the occurrence of temporal lobe radionecrosis (TLN) associated with cognitive dysfunction. Currently, there is no effective intervention to improve patients' cognitive performance. METHODS Twenty‐nine patients with TLN after radiotherapy for NPC were recruited on a voluntary basis. Among them, 19 patients (15 males and 4 females) received a megadose of alpha‐tocopherol (vitamin E) (2000 international units per day) for 1 year, whereas the other 10 (5 males and 5 females) served as control patients. Their cognitive function (i.e., global cognitive ability, attention, memory, language, and executive function) was evaluated by a battery of neuropsychological tests before and after treatment. RESULTS Significant improvement in global cognitive ability (P = 0.035) and memory (verbal: P = 0.036; visual: P = 0.007) occurred among patients in the treatment group after a 1‐year medication period. In addition, the executive function of the treatment group improved significantly (P = 0.04). No difference was found between the two groups with respect to attention or language. CONCLUSIONS The current investigation was a preliminary study on the effect of alpha‐tocopherol on the cognitive function of patients with TLN after radiotherapy for NPC. In view of the absence of effective treatment for patients with cerebral radionecrosis, alpha‐tocopherol has the potential to be a complementary intervention for patients with cognitive dysfunction due to TLN. Cancer 2004;100:398–404. © 2003 American Cancer Society.

We speculate that corticosteroid with higher in-vitro inflammatory potency administered at timing and dosages commensurate with disease severity may be conducive to better outcome from SARS as a consequence of more effective control of immunopathological lung damage.

This large-scale analysis identified important discriminatory parameters related to the patients' demographic profile (age and gender), severity of illness (pulse rate and neutrophil count), and multisystem derangement (platelet count, CPK, ALT and LDH), all of which prognosticated adverse outcomes during the SARS episode. While age, pulse rate and neutrophil count consistently remained significant prognosticators during the first 10 days of illness, the prognostic impact of other derangements was more time-course dependent. Clinicians should be aware of the time-course evolution of these prognosticators.