151. Fatigue following radiation therapy in nasopharyngeal cancer survivors: a dosimetric analysis incorporating patient report and observer rating
- Author
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Aakash Batra, Joshua Smith, Charles S. Cleeland, Joel Berends, Carlos E. Cardenas, Clifton D. Fuller, D.I. Rosenthal, Mona Kamal, Adam S. Garden, Amit Jethanandani, G. Brandon Gunn, Abdallah S.R. Mohamed, Tito R. Mendoza, A. White, Erich M. Sturgis, A. Dursteler, S. Eraj, Jack Phan, Bowman Williams, Stefania Volpe, Ryan P. Goepfert, William H. Morrison, Jeremy M. Aymard, Baher Elgohari, and Steven J. Frank
- Subjects
Adult ,Male ,Pituitary gland ,Internal capsule ,medicine.medical_treatment ,Recursive partitioning ,Article ,030218 nuclear medicine & medical imaging ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cancer Survivors ,Basal ganglia ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiation Injuries ,Radiometry ,Aged ,Fatigue Syndrome, Chronic ,Nasopharyngeal Carcinoma ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Brain ,Common Terminology Criteria for Adverse Events ,Chronic fatigue ,Nasopharyngeal Neoplasms ,Radiotherapy Dosage ,Hematology ,Middle Aged ,Magnetic Resonance Imaging ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Pituitary Gland ,Cohort ,Female ,Radiotherapy, Intensity-Modulated ,Self Report ,Nuclear medicine ,business - Abstract
PURPOSE: To explore for fatigue-related regions of interest and the radiotherapy (RT) dose-fatigue relationship in nasopharyngeal cancer (NPC) survivors. METHODS: Eighty disease-free NPC survivors completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN) after RT. Fatigue was evaluated by the MDASI-HN fatigue item (MDASI-HN-F) and Common Terminology Criteria for Adverse Events v3.0 (CTC-AE), between 6 and 36 months after RT to determine the presence of chronic fatigue. Skull base MRIs and planning CT/RT dose were retrievable for 56 patients. Dosimetric data were extracted for 10 MRI-defined potential fatigue at-risk structures (FARS): brainstem (BS), pituitary gland (PG), hypothalamus (HT), basal ganglia, internal capsule, pineal gland, sub-thalamic nuclei, thalamus, substantia nigra, and hippocampus (HC). Recursive partitioning analysis (RPA) were used to identify dose-volume effects associated with chronic fatigue. RESULTS: 56 pts formed the cohort. Thirty patients (54%) reported any fatigue per MDASI-HN-F. Thirty-three pts (59%) had any fatigue by CTC-AE. The maximum point doses (Dmax) for PG, BS, HC, and HT were numerically higher in patients with fatigue. Dmax and Dmean of the PG were significantly higher in patients with chronic fatigue, p ≤ 0.01. A dose-volume threshold of PG V52Gy ≥16% (Logworth 2.4, AUC 0.7) was identified on RPA, and potential sensitivity to the PG doses was observed in younger patients (< 53 years-old). CONCLUSION: A dose-fatigue relationship was identified for the pituitary gland, both patient-reported and observer ratings. We recommend limiting the Dmax of PG to
- Published
- 2019