Effects Of Chemoradiotherapy On Cognitive Function In Nasopharyngeal Carcinoma:A Cross-sectional Study

Objective: To evaluate the effects of intensity modulated radiotherapy(IMRT)combined with chemotherapy on cognitive processing in patients with nasopharyngeal carcinoma(NPC)and to identify the critical predictors of cognitive disorder.Materials and Methods: We conducted a cross-sectional study of 60 NPC patients diagnosed and treated with curative-intent IMRT at our center during2013-2019.Another 60 comparable newly diagnosed untreated NPC patients were randomly selected as controls.Cognitive function was assessed using DAS-Naglieri: Cognitive Assessment System(DN:CAS),an information processing assessment tool.Meanwhile,the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and Pittsburgh Sleep Quality Index(PSQI)were used for behavioral assessment of anxiety,depression and sleep,respectively.Dose–volume histograms(DVHs)of the temporal lobe(TL)and hippocampus were extracted for statistical analysis.Results: Compared with the pre-RT group,the post-RT group had a significantly lower score on the CAS full-scale(72.23±13.27 vs.63.97±12.49,p=0.001),which manifested in the domains of planned codes,nonverbal matrices,expressive attention,number detection,word series,sentence repetition,and sentence questions(p<0.05 for all).The overall prevalence of depression and anxiety showed an insignificant increase while the prevalence of sleep disorder,standardized SAS,SDS and PSQI scores were significantly higher afer RT(all p<0.005).Patients were classified into 4 subsets by the time since they completed RT(≤9,>9-16,>16-33 and >33 months).The 4 cohorts differed overall for nonverbal matrices,successive subscale including word series,sentence repetition and sentence questions,and full-scale(ANOVA:p<0.05 for all),which was mainly due to improved scores in the >9-16 month cohort compared with the >33 month cohort(post hoc tests: p<0.05 for each domain except for sentence questions).No significant differences were found in depression,anxiety or sleep disorder among the four cohorts.SAS and SDS scores were weakly negatively correlated with targeted therapy.The irradiation doses of the TL and hippocampus in locally advanced NPC were notably higher than those in the early T stage.There were no associations between DN:CAS scores and any of the analyzed dose-volume data.General linear model analysis revealed that duration since RT,education,age at treatment and survey were significant predictors for cognitive impairment.Conclusions: NPC patients treated with chemoradiotherapy exhibit impaired cognitive function,which can be detected by information processing assessment tool,In addition,the emotional state and sleep quality of the patients also decreased,which should be considered in treatment and rehabilitation.