| Objective：the aims of this study were to prospectively explorer cognitivefunction in patients treated with intensity-modulated radiotherapy (IMRT) fornasopharyngeal carcinoma (NPC) and their relationships betweenradiation-induced cognitive impairment and the irradiation dosage and volumeof temporal lobe. Additionally, we also evaluated the quality of sleep, anxiety,and depression before and after IMRT, and investigated the predictors for sleepdisorders, anxiety, and depression after IMRT. In order to provide the basis forpreventing side effects of radiotherapy (RT) and improve quality of life aftertreatment with RT.Methods：Between December2012and July2013,51patients withpathologically diagnosed as non-metastasis NPC treated with primary IMRTwere included. Target and organs at risk (include temporal lobes) were eachcontoured on CT image, and then began irradiation when the planning hadpassed. Dose–volume histograms (DVH) of the temporal lobes were obtained inevery patien. All patients received a cranial MRI exam before and after IMRT. The Electronic Cognitive Assessment System (E-CAS), Pittsburgh SleepQuality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-RatingDepression Scale (SDS) were performed to assess cognitive function, quality ofsleep, anxiety and depression in NPC patients before treatment and within aweek after IMRT, respectively. The paired-sample t test, McNemar’s test ornonparametric test were used to determine the exact significance of thedifferences in cognitive function, PSQI scores, SAS and SDS scores before andafter RT. Their relationships were analyzed by multiple linear regression orLogistic regression models.Results：The mean doses to the left and right temporal lobes were18.9±2.8Gy (2.3-70.5Gy) and19.3±4.3Gy (2.6-71.3Gy), and the mean value (V65) of theleft and right temporal lobes was1.1±1.9%and1.6±2.3%, respectively. Noradiation-induced brain injury or radionecrosis was found in all participantsduring the follow-up MRI. The standard scores of the Planned codes, Nonverbalmatrices, Figure memory, Receptive attention, and Sentence questions subtestsafter RT tended to be lower than baseline scores, while the scores of theMatching numbers, Planned connections, Verbal–spatial relations, Expressiveattention, Number detection, Word series, and Sentence repetition subtests werea little higher post-RT than those before treatment. However, no statisticallysignificant differences were found between them (P＞0.05). Before irradiation,the overall prevalence of anxiety, depression, and poor quality of sleep was3.9%,3.9%, and37.3%, respectively. But there were significant increase aftertreatment (19.6%,39.2%,64.7%). The observed increase in mean global PSQIscores was statistically significant, compared with pre-RT scores (8.0±4.3vs.5.2±3.6, P=0.023). Additionally, the mean standardized scores of SDS and SAS were much higher post-RT than those at baseline (50.3±9.9vs.40.0±8.5, P=0.000;43.4±9.1vs.37.2±6.7, P=0.002). Multiple linear regression andLogistic regression analysis revealed that the mean scores of SAS, SDS, andPSQI before treatment were significant predictors of post-RT SAS, SDS, andPSQI scores, respectively. Younger age was also associated with SAS and SDSscores after treatment.Conclusions：The present study indicated that there was no acute change incognitive function after IMRT, compared with pre-RT. However, the prevalenceand severity of depression, anxiety and sleep disturbance significantly increased.The depression, anxiety and poor sleep pre-RT was associated with theirnegative mood and poor sleep post-RT, and younger age was also correlatedwith depression and anxiety after RT, younger patients were more likely todevelop depression and anxiety at the end of treatment. Although there was noacute cognitive deficits resulting from IMRT, but the long-term effects of RTmight still warrant concern. |
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