title: Neurocognitive function after (chemo)-radiotherapy for head and neck cancer.
abstract: Radical radiotherapy has a pivotal role in the treatment of head and neck cancer (HNC) and cures a significant proportion of patients while simultaneously sparing critical normal organs. Some patients treated with radical radiotherapy for HNC receive significant radiation doses to large volumes of brain tissue. In fact, intensity-modulated radiotherapy techniques for HNC have been associated with a net increase in irradiated brain volumes. The increasing use of chemoradiotherapy for HNC has additionally exposed this patient population to potential neurotoxicity due to cytotoxic drugs. Patients with HNC may be particularly at risk for adverse late brain effects after (chemo)-radiotherapy, such as impaired neurocognitive function (NCF), as risk factors for the development of HNC, such as smoking, excess alcohol consumption and poor diet, are also associated with impaired NCF. The relatively good survival rates with modern treatment for HNC, and exposure to multiple potentially neurotoxic factors, means that it is important to understand the impact of (chemo)-radiotherapy for HNC on NCF, and to consider what measures can be taken to minimise treatment-related neurotoxicity. Here, we review evidence relating to the late neurotoxicity of radical (chemo)-radiotherapy for HNC, with a focus on studies of NCF in this patient population.
authors.affiliation: The Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Welsh
authors.affiliation: The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: A W
authors.initials: AW
authors.lastname: Dunlop
authors.affiliation: The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: T
authors.initials: T
authors.lastname: McGovern
authors.affiliation: The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: McQuaid
authors.affiliation: The Institute of Cancer Research, Sutton, Surrey, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Dean
authors.affiliation: The Institute of Cancer Research, Sutton, Surrey, UK.
authors.forename: S L
authors.initials: SL
authors.lastname: Gulliford
authors.affiliation: The Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Bhide
authors.affiliation: The Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Harrington
authors.affiliation: The Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Nutting
authors.affiliation: The Royal Marsden Hospital, Sutton, Surrey, UK. Electronic address: Kate.Newbold@rmh.nhs.uk.
authors.forename: K L
authors.initials: KL
authors.lastname: Newbold
mesh_terms: D059248:Chemoradiotherapy; D003072:Cognition Disorders / Q000139:chemically induced / Q000209:etiology*; D015331:Cohort Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology / Q000532:radiotherapy*; D006801:Humans; D009483:Neuropsychological Tests; D011832:Radiation Injuries / Q000209:etiology* / Q000523:psychology; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods
keywords: Chemotherapy; head and neck cancer; neurocognitive impairment; radiotherapy