Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

• Type of Material: Article
• Authors: Matthew J. Ferris, Emory University; Jim Zhong, Emory University; Jeffrey M. Switchenko, Emory University; Kristin Higgins, Emory University; Richard Cassidy, Emory University; Mark W. McDonald, Emory University; Bree R. Eaton, Emory University; Kirtesh Patel, Emory University; Conor Ermst Steuer, Emory University; Harry Michael Baddour Jr, Emory University; Andrew H Miller, Emory University; Deborah W. Bruner, Emory University; Canhua Xiao, Emory University; Jonathan J Beitler, Emory University
• Language: English
• Date: 2018-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.radonc.2017.08.008
• Title of Journal or Parent Work: Radiotherapy and Oncology
• ISSN: 0167-8140
• Volume: 126
• Issue: 1
• Start Page: 100
• End Page: 106
• Grant/Funding Information: This study was supported by NIH/NINR K99R00NR014587 and the Oncology Nursing Society Foundation.; Research reported in this publication was also supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: CHEMORADIOTHERAPY; BREAST-CANCER; SURVIVORS; Radiology, Nuclear Medicine & Medical Imaging; BURDEN; MODULE; Oncology; Brain dose; CHEMORADIATION; Head and neck cancer; Radiation therapy; CONSECUTIVE PATIENTS; Life Sciences & Biomedicine; ANDERSON SYMPTOM INVENTORY; Science & Technology; RADIOTHERAPY; Quality of life; QUALITY-OF-LIFE; Fatigue
• Research Categories: Health Sciences, Oncology; Biology, Bioinformatics; Biology, Biostatistics

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 1. Gy 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 1. Gy 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.