Medical Ultrasound Imaging Center (MUSIC), Department of Medical Imaging/Radiology, Radboud Institute Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
BMC Cancer. 2022 Mar 5;22(1):244. doi: 10.1186/s12885-022-09295-9.
With a growing, younger population of head and neck cancer survivors, attention to long-term side-effects of prior, often radiotherapeutic, treatment is warranted. Therefore, we studied the long-term cognitive effects in young adult patients irradiated for head and neck neoplasms (HNN).
Young to middle-aged adults with HNN (aged 18-40 years) and treated with unilateral neck irradiation ≥ 5 years before inclusion underwent cardiovascular risk and neuropsychological assessments and answered validated questionnaires regarding subjective cognitive complaints, fatigue, depression, quality of life, and cancer-specific distress. Additionally, magnetic resonance imaging (MRI) of the brain was performed to assess white matter hyperintensities (WMH), infarctions, and atrophy.
Twenty-nine patients (aged 24-61, 13 men) median 9.2 [7.3-12.9] years post-treatment were included. HNN patients performed worse in episodic memory (Z-score = -1.16 [-1.58-0.34], p < 0.001) and reported more fatigue symptoms (Z-score = 1.75 [1.21-2.00], p < 0.001) compared to normative data. Furthermore, patients had a high level of fear of tumor recurrence (13 patients [44.8%]) and a heightened speech handicap index (13 patients [44.8%]). Only a small number of neurovascular lesions were found (3 infarctions in 2 patients and 0.11 [0.00-0.40] mL WMH), unrelated to the irradiated side. Cognitive impairment was not associated with WMH, brain atrophy, fatigue, or subjective speech problems.
HNN patients showed impairments in episodic memory and an increased level of fatigue ≥ 5 years after radiotherapy compared to normative data. Cognitive impairments could not be explained by WMH or brain atrophy on brain MRI or psychological factors.
Clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT04257968 ).
随着头颈癌幸存者群体的不断扩大和年轻化，有必要关注既往治疗（通常为放疗）的长期副作用。因此，我们研究了接受单侧颈部放疗的年轻成年头颈癌（HNN）患者的长期认知影响。
年龄在 18-40 岁之间的 HNN 患者，在入组前 5 年以上接受单侧颈部放疗，接受心血管风险和神经心理评估，并回答关于主观认知主诉、疲劳、抑郁、生活质量和癌症特异性困扰的经过验证的问卷。此外，对大脑进行磁共振成像（MRI）以评估白质高信号（WMH）、梗死和萎缩。
共纳入 29 例患者（年龄 24-61 岁，男性 13 例），中位治疗后时间为 9.2 年[7.3-12.9]。与正常数据相比，HNN 患者的情景记忆表现更差（Z 分数=-1.16[-1.58-0.34]，p<0.001），且报告的疲劳症状更多（Z 分数=1.75[1.21-2.00]，p<0.001）。此外，患者对肿瘤复发的恐惧程度较高（13 例[44.8%]），言语障碍指数升高（13 例[44.8%]）。仅发现少量神经血管病变（2 例患者 3 个梗死和 2 例患者 0.11[0.00-0.40]毫升 WMH），与放疗侧无关。认知障碍与 WMH、脑萎缩、疲劳或主观言语问题无关。
与正常数据相比，HNN 患者在放疗后 5 年以上表现出情景记忆障碍和疲劳水平升高。认知障碍不能用 MRI 脑上的 WMH 或脑萎缩或心理因素来解释。
Clinicaltrials.gov（https://clinicaltrials.gov/ct2/show/NCT04257968）。
