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

J. Wilbers, A. Kappelle, R. Kessels, S. Steens, F. Meijer, J. Kaanders, R. Haast, L. Versteeg, A. Tuladhar, C. de Korte, H. Hansen, F. Hoebers, W. Boogerd, E. van Werkhoven, M. Nowee, G. Hart, H. Bartelink, L. Dorresteijn and E. van Dijk

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. Joyce.Wilbers@radboudumc.nl.



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.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.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.