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

作者：Ferris Matthew J; Zhong Jim; Switchenko Jeffrey M; Higgins Kristin A; Cassidy Richard J III; McDonald Mark' W; Eaton Bree R; Patel Kirtesh R; Steuer Conor E; Baddour H Michael Jr; Miller Andrew H; Bruner Deborah W; Xiao Canhua; Beitler Jonathan J

来源：Radiotherapy and Oncology, 2018, 126(1): 100-106.

DOI：10.1016/j.radonc.2017.08.008

• Head and neck cancer
• Fatigue
• Radiation therapy
• Quality of life
• Brain dose

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.

• 出版日期2018-1