Yaniv Dan, Niccolai Lindsay M, Wefel Jeffrey S, Sullaway Catherine M, Phan Jack, Fuller Clifton David, Haroun Kareem B, Hanna Ehab Y, Su Shirley Y
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
J Neurol Surg B Skull Base. 2023 Sep 27;85(6):614-621. doi: 10.1055/s-0043-1775753. eCollection 2024 Dec.
Few recent studies have examined neurocognitive functioning (NCF) in patients with sinonasal and nasopharyngeal cancers (NPCs) prior to and following multimodality therapy or the potential differences in NCF by disease variables such as disease site. The objective of this study is to determine rates of NCF impairments prior to and following multimodality therapy, declines in NCF following radiotherapy (RT), and possible differences in NCF by the disease site. We conducted a retrospective chart review of 39 patients with sinonasal and NPCs who underwent comprehensive neuropsychological evaluations. Twenty patients were evaluated prior to RT, of which eleven received follow-up evaluation after completion of RT. Nineteen patients were evaluated following various treatments without a pre-RT evaluation. Patients completed comprehensive neuropsychological evaluations. Decline from pre-RT to follow-up was defined on the basis of reliable change indices. Thirty-nine patients completed comprehensive neuropsychological evaluations. For the entire cohort, the most frequently demonstrated impairments were in verbal memory (47%) and learning (43%), executive functioning (33%), and verbal fluency (22%). At post-RT follow-up, the most frequently observed declines were in verbal learning (46%) and memory (18%). Demographic and disease variables were not significantly associated with NCF at pre-RT or post-RT. Patients with sinonasal and NPCs are at risk for NCF impairments in multiple areas at baseline and memory decline following RT. Future prospective studies are needed to investigate the impact of each treatment modality on NCF and specific risk factors for cognitive dysfunction.
近期很少有研究探讨鼻窦癌和鼻咽癌（NPC）患者在多模式治疗前后的神经认知功能（NCF），或疾病部位等疾病变量在NCF方面的潜在差异。 本研究的目的是确定多模式治疗前后NCF损害的发生率、放疗（RT）后NCF的下降情况，以及疾病部位在NCF方面可能存在的差异。 我们对39例接受全面神经心理学评估的鼻窦癌和NPC患者进行了回顾性病历审查。20例患者在放疗前接受了评估，其中11例在放疗完成后接受了随访评估。19例患者在接受各种治疗后接受了评估，但未进行放疗前评估。 患者完成了全面的神经心理学评估。根据可靠变化指数定义从放疗前到随访的下降情况。 39例患者完成了全面的神经心理学评估。对于整个队列，最常出现的损害是言语记忆（47%）、学习（43%）、执行功能（33%）和言语流畅性（22%）。在放疗后随访中，最常观察到的下降是言语学习（46%）和记忆（18%）。人口统计学和疾病变量在放疗前或放疗后与NCF均无显著相关性。 鼻窦癌和NPC患者在基线时多个领域存在NCF损害风险，放疗后存在记忆下降风险。未来需要进行前瞻性研究，以调查每种治疗方式对NCF的影响以及认知功能障碍的特定风险因素。
