• Lachlan J McDowell, Jolie Ringash, Wei Xu, Biu Chan, Lin Lu, John Waldron, Kathy Rock, Nathaniel So, Shao Hui Huang, Meredith Giuliani, Andrew Hope, Brian O'Sullivan, Scott V Bratman, John Cho, John Kim, Raymond Jang, Andrew Bayley, and Lori J Bernstein.
• Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
• Radiother Oncol. 2019 Feb 1; 131: 179-185.

Purpose/ObjectivesTo determine neurocognitive and neurobehavioral impairment in long-term nasopharyngeal cancer survivors (NPC) treated with intensity-modulated radiotherapy (IMRT).Materials/MethodsA cross-sectional cohort of NPC ≥4 years (y) following IMRT was assessed. Objective cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and patient-reported memory was assessed with the MDASI-HN problems remembering item. Patient and family ratings of patients' neurobehavioral symptoms of apathy, disinhibition and executive dysfunction were assessed with the Frontal Systems Behavior Scale (FrSBe). Other patient-reported symptoms (MDASI-HN), mood (HADS), and quality of life (FACT-H&N) were also collected.ResultsAmong 102 participants: M:F = 66:36; median age 56y (32-77); median time since IMRT 7.5y (4.2-11.1). Impaired MoCA scores (<23) were observed in 33 (32%). Patient and family ratings of pre-illness neurobehavioral symptoms were in the normal range (total FrSBe T-scores 53.3 and 59.0 respectively). In contrast, post-treatment patient and family T-scores were clinically impaired (64.7, 71.3 respectively), with apathy, disinhibition and executive dysfunction post-treatment ratings all significantly worse than pre-treatment (p < 0.001). Prevalence of clinically significant post-treatment disturbance was high by patient and family ratings (48%/66% apathy, 35%/53% disinhibition, 39%/56% executive dysfunction). Post-treatment neurobehavioral symptoms strongly correlated with lower quality of life (r = -0.62) and higher anxiety (r = 0.62) and depression scores (r = 0.67, all p < 0.001). Total MoCA scores did not correlate with RT dose. However, greater declines in apathy, disinhibition and executive dysfunction were associated with receiving >75 Gy to temporal lobes.ConclusionNPC treated with IMRT had moderate to high rates of neurocognitive impairment and clinically significant apathy, disinhibition, and executive dysfunction.Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

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