The Impact Of Radiotherapy Alone And Chemoradiotherapy On Attention In Patients With Nasopharyngeal Cancer

Objective : To prospectively evaluate the short-term effects of intensity-modulated radiotherapy (IMRT) and cisplatin concurrent chemoradiotherapy (CCRT) on attention in patients with nasopharyngeal cancer(NPC) and to explore the potential influence factors.Methods: Thirty-eight patients with NPC treated with IMRT (17/38) or CCRT (21/38) and thirty-eight healthy controls were recruited for the study.Neuropsychologic tests including the integrated visual and auditory continuous performance test (IVA-CPT), self-rating anxiety scale (SAS ) , self-rating depression scale (SDS) and pittsburgh sleep quality index (PSQI) were administered individually to each patient before initiation and within a week after completion of treatment. Healthy controls underwent the same assessments with a similar time interval. In addition, all of the patients received a cranial magnetic resonance imaging (MRI) exam before and after the treatment.The change in attention performance over time was evaluated by differences in scores (D-values) between the two tests.Results: No radionecrosis was identified in the 38 patients according to the cranial MRI. At baseline, the quotient scores for vigilance and speed, both auditory and visual, were significantly lower in patients with NPC than in healthy controls (P=0.001,P=0.002,P=0.037,P=0.020). Compared with healthy controls, the D-values for auditory stamina (AS) were significantly higher in patients with IMRT alone (P=0.042), while the D-values for the full-scale response control quotient (FSRCQ) were significantly lower in patients with CCRT (P=0.030). At baseline, the incidence of sleep disorder in patients were significantly higher than healthy controls (28.9% vs.7.9%, P =0.018).The incidence of depression and sleep disorder in patients increased considerably when compared to the baseline (31.6% VS 7.9%, P=0.009; 68.4%VS 28.9%, P=0.001)? A significant, negative correlation among pre-RT SDS scores, pre-RT PSQI scores and pre-RT auditory speed was found (correlation coefficient r = -0.374, P = 0.021; r = -0.430, P = 0.007). As for pre-RT visual vigilance, it was found to be related to the age and gender (r = 0.321, P = 0.048;r = -0.433, P = 0.007). The D-value for FSRCQ in CCRT was considerably related to the educational background and post-treatment PSQI scores (r = 0.434,P = 0.049; r = -0.479, P = 0.028).Conclusions: A decrease in attention was already present in patients with NPC prior to treatment. Male or younger patients with depression, or poor sleep were more likely to have attention decline pre-treatment. IMRT has no negative acute effects on attention in patients with NPC,while CCRT contributes to a decrease in response control. Patients with sleep disorder after RT and lower education were at increased risk of response control decrease. The incidence of depression and sleep disorder in patients increased after treatment.