Fatigue during chemoradiotherapy for nasopharyngeal cancer and its relationship to radiation dose distribution in the brain

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

“…One explanation for these differences is that the patient population in that analysis received considerably higher doses to the brainstem and cerebellum compared to the patient population in our study. Similarly, our study did not concord with the results of Powell et al which described associations between provider-assessed grade 2 or higher fatigue and increased RT dose to the pituitary, cerebellum, and basal ganglia [3]. Their study consisting of only patients with nasopharyngeal cancer may be related to their demonstration of a relationship between fatigue and pituitary and cerebellum dosimetry—again, their patient population typically received higher doses to both structures than the patient population in our study, which contained mixed HNC primary sites.…”

“…While we do believe the basal ganglia is likely to be an at-risk structure, our patient population did not, by our estimation, receive high enough doses to this area of the brain so that an effect might have been demonstrated. Again, this is due to our inclusion of mixed HNC primary sites; Powell et al's study population [3], which included only patients with nasopharyngeal cancers, received higher doses to the basal ganglia in general, and thus they were able to demonstrate a relationship between dose and fatigue.…”

“…A subsequent dosimetric analysis of the trial was conducted to investigate this rare instance in which a side-effect was not improved with IMRT, and it found that higher doses were delivered to the posterior fossa, brainstem, and cerebellum in the patients who reported worse acute fatigue [2]. These authors later analyzed the evolution of fatigue levels in a series of patients undergoing IMRT for nasopharyngeal cancer and found correlation between fatigue and increased doses to the basal ganglia, pituitary, and cerebellum; they suggest disruption of the pituitary axis and activating pathways associating the basal ganglia, cerebellum, and higher cortical centers as possible contributors to RT-induced fatigue [3]. These suggestions connecting central nervous system (CNS) structure damage to fatigue have correlates in studies using functional brain imaging to analyze fatigue in multiple sclerosis, depression and chronic fatigue syndrome [4–13].…”

Evaluation of the Risk of Grade 3 Oral and Pharyngeal Dysphagia Using Atlas-Based Method and Multivariate Analyses of Individual Patient Dose Distributions

“…Details of the trial protocols can be found in the relevant publications (14)(15)(16), Table 1 and the Supplementary Data (available online at www.redjournal .org). Patients <71 years old with stage III or IV HNSCC and all those with nasopharyngeal cancer received ICC (2 cycles cisplatin and 5-fluorouracil) followed by CRT (cisplatin days 1 and 29); the regimens have previously been described in detail (17).…”

Strengthened Corticosubcortical Functional Connectivity during Muscle Fatigue

“…The observed fatigue symptom in MS thus likely is due to abnormal activation as a consequence of hypometabolism in the organ. Fatigue symptoms induced by radiation and/or chemodrugs during chemotherapy or radiotherapy in cancer patients were found to be related to the dosage of radiation to a variety of brain regions including the BG [26]. …”