Multi-domain neurocognitive impairment following definitive intensity-modulated radiotherapy for nasopharyngeal cancer: A cross-sectional study.

Autor: Chow JCH; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China., Lee J; Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China., Lai MMP; Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China., Li S; Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China., Lau AMC; Department of Clinical Psychology, Queen Elizabeth Hospital, Hong Kong SAR, China., Ng BSY; Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China., Leung GGG; Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China., Li STY; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China., Lui JCF; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China., Cheung KM; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China., Au KH; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China., Wong KH; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China., Lau AYL; Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China., Zee BCY; Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address: bzee@cuhk.edu.hk.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Apr; Vol. 193, pp. 110143. Date of Electronic Publication: 2024 Feb 08.
DOI: 10.1016/j.radonc.2024.110143
Abstrakt: Introduction: Neurocognitive impairment from inadvertent brain irradiation is common following intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). This study aimed to determine the prevalence, pattern, and radiation dose-toxicity relationship of this late complication.
Materials and Methods: We undertook a cross-sectional study of 190 post-IMRT NPC survivors. Neurocognitive function was screened using the Montreal Cognitive Assessment-Hong Kong (HK-MoCA). Detailed assessments of eight distinct neurocognitive domains were conducted: intellectual capacity (WAIS-IV), attention span (Digit Span and Visual Spatial Span), visual memory (Visual Reproduction Span), verbal memory (Auditory Verbal Learning Test), processing speed (Color Trail Test), executive function (Stroop Test), motor dexterity (Grooved Pegboard Test) and language ability (Verbal Fluency Test). The mean percentiles and Z-scores were compared with normative population data. Associations between radiation dose and brain substructures were explored using multivariable logistic regression.
Results: The median post-IMRT interval was 7.0 years. The prevalence of impaired HK-MoCA was 25.3 % (48/190). Among the participants, 151 (79.4 %) exhibited impairments in at least one neurocognitive domain. The predominantly impaired domains included verbal memory (short-term: mean Z-score, -0.56, p < 0.001; long-term: mean Z-score, -0.70, p < 0.001), processing speed (basic: mean Z-score, -1.04, p < 0.001; advanced: mean Z-score, -0.38, p < 0.001), executive function (mean Z-score, -1.90, p < 0.001), and motor dexterity (dominant hand: mean Z-score, -0.97, p < 0.001). Radiation dose to the whole brain, hippocampus, and temporal lobe was associated with impairments in executive function, verbal memory, processing speed, and motor dexterity.
Conclusions: Neurocognitive impairment is prevalent and profound in post-IMRT NPC survivors. Cognitive assessment and rehabilitation should be considered part of survivorship care.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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