Matthew J Ferris1, Jim Zhong2, Jeffrey M Switchenko3, Kristin A Higgins2, Richard J Cassidy2, Mark W McDonald2, Bree R Eaton2, Kirtesh R Patel2, Conor E Steuer4, H Michael Baddour5, Andrew H Miller6, Deborah W Bruner7, Canhua Xiao8, Jonathan J Beitler2. 1. Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA. Electronic address: mjferri@emory.edu. 2. Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA. 3. Winship Cancer Institute of Emory University, Atlanta, USA; Department of Biostatistics & Bioinformatics, Emory University, Atlanta, USA. 4. Winship Cancer Institute of Emory University, Atlanta, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, USA. 5. Winship Cancer Institute of Emory University, Atlanta, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, USA. 6. Winship Cancer Institute of Emory University, Atlanta, USA; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA. 7. Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA. 8. Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA.
Abstract
BACKGROUND AND PURPOSE: Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. MATERIALS AND METHODS: At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. RESULTS: Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p<0.05). Each 1Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.026), and 0.25 (p=0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.027), and 0.25 (p=0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. CONCLUSIONS: In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue.
BACKGROUND AND PURPOSE: Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. MATERIALS AND METHODS: At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. RESULTS: Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p<0.05). Each 1Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.026), and 0.25 (p=0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.027), and 0.25 (p=0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. CONCLUSIONS: In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patientfatigue.
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