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. 

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

Background: Brain radiotherapy is an indispensable mainstay treatment for the majority of brain tumors. It has an important role in the treatment of brain tumors either with curative intent or for palliation. Although radiotherapy is well tolerated by most patients, some experience radiation-induced side effects. Aim of the study: To assess the needs of patients receiving brain radiotherapy at fayoum oncology center. Design: Descriptive exploratory research design was used to conduct this study. Setting: The study was conducted in the radiotherapy unit at Fayoum Oncology Center at fayoum governorate. Subjects: A purposive sample of 60 adult patients from both gender receiving brain radiotherapy.  Tools: A structured interviewing questionnaire included socio-demographic data, medical history, surgical history and patients' health needs assessment questionnaire. Results: the highest unfulfilled health needs of patients treated with brain radiotherapy were discomfort, activities of daily living, anxiety and depression. There is statistically significant correlation between physical health needs, psychological and social health needs. Additionally, there is statistically significant correlation between physical discomfort and anxiety and between physical discomfort and depression Conclusion: The study concluded that the patients suffered from unfulfilled health needs physical, social and psychological. 

needs of patients receiving brain radiotherapy at Fayoum oncology center

Timeline of cognitive impairments after radiotherapy for head and neck cancer: A review

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 ). 

/pdf/long-term-cognitive-psychosocial-and-neurovascular-1uhcg6lt.pdf

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

https://bmccancer.biomedcentral.com/track/pdf/10.1186/s12885-022-09295-9

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

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