Progressive Neurocognitive Decline Observed In Radiotherapy-Treated HNSCC Patients

Head and neck cancer patients remain at risk of long-term neurocognitive deficits after undergoing definitive radiotherapy or chemoradiotherapy

medwireNews: Patients with head and neck squamous cell cancer (HNSCC) can experience neurocognitive problems up to 2 years after undergoing radiotherapy or chemoradiotherapy, research findings indicate.

“These adverse cognitive risks should be communicated to patients and families”, say the study authors, adding that “[s]trategies to reduce toxic effects and cognitive rehabilitation options should be available for [head and neck cancer] survivors.”

They enrolled 80 patients with newly diagnosed, nonmetastatic HNSCC who were due to undergo definitive radiotherapy or chemoradiotherapy and 40 noncancer controls, all of whom completed a 90-minute battery of neurocognitive assessments. Patients were evaluated at baseline (≤2 weeks before therapy initiation), at treatment completion (6 months after baseline), and at 12 and 24 months after baseline, while control participants completed the tests at similar intervals.

Using standardised regression-based (SRB) models adjusted for baseline performance, age, education and depression scores, the researchers found significant differences between the average performance of patients and controls in some domains, “with patient deficits increasing over time.”

Specifically, HNSCC patients showed declines in global cognitive function and in the domains of intellectual capacity, concentration/short-term attention span, verbal memory, executive function and motor dexterity at all post-baseline timepoints, compared with control participants, although the two groups did not differ significantly in terms of processing speed and visual memory.

Furthermore, researcher Lori Bernstein, from the Princess Margaret Cancer Centre & University of Toronto in Ontario, Canada, and colleagues say that at the 6-month mark the cohorts were comparable with regard to the proportions experiencing a significant neurocognitive decline, defined as a decrease in the SRB score of at least 1.64 points from baseline, in all domains.

But by the 24-month assessment, a significantly larger proportion of patients than controls exhibited declines in the domains of intellectual capacity (27 vs 3%), verbal memory (21 vs 3%), processing speed (12 vs 0%), executive function (26 vs 6%) and motor dexterity (10 vs 0%).

Of note, 38% of patients showed significant deficits in global cognitive function at this timepoint versus none of the controls, which is “especially concerning, suggesting that patients are at high risk of suffering from delayed and progressive neurocognitive sequelae 2 years after treatment”, the investigators write in JAMA Otolaryngology–Head & Neck Surgery.

They continue: “Clinical implications of [neurocognitive deficits] in the context of organ-sparing curative treatment for aggressive cancer might seem modest. However, cancer survivors with [such problems] are less likely to return to work, be involved in the community, and function socially.

“Potential strategies to avoid [neurocognitive deficits] include hippocampus-sparing radiation techniques, cognitive prehabilitation or rehabilitation, and development of neuroprotectors.”


Zer A, Pond GR, Razak ARA, et al. Association of neurocognitive deficits with radiotherapy or chemoradiotherapy for patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg; Advance online publication 22 November 2017. doi: 10.1001/jamaoto.2017.2235

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