Long-term cognitive, psychosocial, and neurovascular complications of unilateral head and neck irradiation in young to middle-aged adults

Abstract

Background 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). Methods 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. Results 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. Conclusions 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. Trial registration Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04257968).

needs of patients receiving brain radiotherapy at Fayoum oncology center

“…Ghadjar, et al, (2021) who studied "External application of liver compresses to reduce fatigue in patients with metastatic cancer undergoing radiation therapy" reported that, Fatigue reported in ≥ 30% of patients of cancer patients during radiation therapy. Also, in accordance with the present studyPruijssen, et al, (2022) reported that in patients receiving head and neck radiotherapy fatigue was highly prevalent: 51.7% experienced severe fatigue (subjective fatigue score ≥ 35). On the same way, the study ofYang, et al, (2022) reported that, of all the patients receiving radiotherapy, 12.1% (15/124) patients developed gastric symptoms including loss of appetite and nausea.In the same way, Iglseder, et al, (2022) reported that, 20% of the patients receiving radiotherapy experienced acute Neurological side effects as headache due to increased intracranial pressure.…”