Open Access Study protocol

Long term cerebral and vascular complications after irradiation of the neck in head and neck cancer patients: a prospective cohort study: study rationale and protocol

Joyce Wilbers1*, Arnoud C Kappelle1, Roy PC Kessels4, Stefan CA Steens3, Frederick JA Meijer3, Johannes H Kaanders2, Roy AM Haast10, Laura E Versteeg4, Anil M Tuladhar1, Chris L de Korte10, Hendrik HG Hansen10, Frank J Hoebers8, Willem Boogerd5, Erik D van Werkhoven7, Marlies E Nowee6, Guus Hart7, Harry Bartelink6, Lucille D Dorresteijn9 and Ewoud J van Dijk1

Author Affiliations

1 Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience, PO box 9101, 6500 HB Nijmegen, The Netherlands

2 Department of Radiation Oncology Radboud University Nijmegen Medical Center, PO box 9101, 6500 HB Nijmegen, The Netherlands

3 Department of Radiology, Radboud University Medical Center, PO box 9101, 6500 HB Nijmegen, The Netherlands

4 Department of medical psychology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE Nijmegen, The Netherlands

5 Department of Neurology, Netherlands Cancer Institute/ Antoni van Leeuwenhoek Hospital, PO box 90203, 1006 BE Amsterdam, The Netherlands

6 Department of Radiotherapy, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, The Netherlands

7 Department of Biometrics, Netherlands Cancer Institute/ Antoni van Leeuwenhoek Hospital, PO box 90203, 1006 BE Amsterdam, The Netherlands

8 Maastricht University Medical Center, Department of Radiation Oncology (MAASTRO clinic), GROW School for Oncology and Developmental Biology, PO box 3035, 6202 NA Maastricht, The Netherlands

9 Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, The Netherlands

10 Medical Ultrasound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein zuid 10, 6525 GA Nijmegen, The Netherlands

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BMC Neurology 2014, 14:132  doi:10.1186/1471-2377-14-132

Published: 19 June 2014

Abstract

Background

Successful treatment options for cancer result in more young long-term survivors prone for long-term complications. Carotid artery vasculopathy is a potential long-term complication after radiotherapy of the neck, resulting in cerebrovascular events and probably deficits in cognitive and motor functioning. Better insight into the underlying pathofysiology of radiotherapy induced carotid artery vasculopathy is needed for prognostic purposes and to develop preventive strategies.

Methods/Design

The current study is a prospective cohort study on the long-term cerebral and vascular complications after radiotherapy of the neck, in 103 patients treated for head and neck cancer, included in our study database between 2002 and 2008. Baseline protocol (before radiotherapy) included screening for cerebrovascular risk factors and intima media thickness measurement of carotid arteries by ultrasonography. Follow-up assessment more than 5 years after radiotherapy included screening of cerebrovascular risk factors, cerebrovascular events, neurological examination with gait and balance tests, extensive neuropsychological examination, self-report questionnaires, ultrasonography of the carotid arteries with measurement of intima media thickness and elastography, magnetic resonance imaging of the brain and magnetic resonance angiography of the carotid arteries.

Discussion

The current study adds to the understanding of the causes and consequences of long-term cerebral and vascular changes after radiotherapy of the neck. These data will be helpful to develop a protocol for diagnostic and preventive strategies for long-term neurological complications in future head and neck cancer patients with anticipated radiotherapy treatment.

Keywords:
Head and neck cancer; Cerebrovascular disease; Carotid artery; Radiation vasculopathy