Neurocognitive function following (chemo)radiotherapy for nasopharyngeal cancer and other head and neck cancers: A systematic review

• Published in: Radiotherapy and oncology Vol. 188; p. 109863
• Main Authors: Iyizoba-Ebozue, Zsuzsanna, Prestwich, Robin, Brown, Sarah, Hall, Emma, Lilley, John, Lowe, Matthew, Thomson, David J, Slevin, Finbar, Boele, Florien, Murray, Louise
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2023
• Subjects: Head and neck cancer; Neurocognition; Quality of life; Radiotherapy; Head and neck cancer; Neurocognition; Radiotherapy; Quality of life
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2023.109863

•Limited data exist on neurocognitive functioning following radiotherapy for head and neck cancer.•Inferior neurocognitive outcomes were demonstrated in patients when compared to control group at 12 months and beyond radiotherapy in several studies.•Most impacted neurocognitive domains were memory and language, potentially due to radiation dose to hippocampus, temporal lobe, and posterior cerebellum.•MRI is a valuable non-invasive tool for the detection of microstructural and functional changes early on, which could be indicative of cognitive changes in the future. When radiotherapy is used in the treatment of head and neck cancers, the brain commonly receives incidental doses of radiotherapy with potential for neurocognitive changes and subsequent impact on quality of life. This has not been widely investigated to date. A systematic search of MEDLINE, EMBASE, Psycinfo Info and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases was conducted. Of 2077 records screened, 20 were eligible comprising 1308 patients. There were no randomised studies and 73.3% of included patients were from single center studies. IMRT was delivered in 72.6% of patients, and chemotherapy used in 61%. There was considerable heterogeneity in methods. Narrative synthesis was therefore carried out. Most studies demonstrated inferior neurocognitive outcomes when compared to control groups at 12 months and beyond radiotherapy. Commonly affected neurocognitive domains were memory and language which appeared related to radiation dose to hippocampus, temporal lobe, and cerebellum. Magnetic Resonance Imaging could be valuable in the detection of early microstructural and functional changes, which could be indicative of future neurocognitive changes. In studies investigating quality of life, the presence of neurocognitive impairment was associated with inferior quality of life outcomes. (Chemo)radiotherapy for head and neck cancer appears to be associated with a risk of long-term neurocognitive impairment. Few studies were identified, with substantial variation in methodology, thus limiting conclusions. High quality large prospective head and neck cancer studies using standardised, sensitive, and reliable neurocognitive tests are needed.