Struikmans, F. (2014) Radiotherapie geïnduceerde moeheid bij hoofdhalstumoren. thesis, Medicine.
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Abstract
Purpose: Previous studies showed that patients treated with intensity modulated radiotherapy showed significantly more fatigue as compared to those treated with the conventional 3D-CRT technique. This could be due to a higher radiation dose to the posterior fossa. The aim of this study was to test the hypothesis that a higher radiation dose to the brainstem and brain results in more fatigue. Methods and materials: The study design was a retrospective analysis of prospectively collected data. The study population was composed of 179 patients treated for head and neck cancer with definitive radiotherapy or concomitant chemoradiation. In all patients, follow up data on fatigue was available up to 24 months after treatment. Dosimetric parameters of the brainstem and brain were derived from the dose volume histograms (DVH’s). Except for dosimetric data, also other pretreatment patients and treatment variables were available, like age, gender, WHO-score etc. To investigate the possible relation between dosimetric and other variable with fatigue after radiotherapy, univariate and multivariate regression analyses were performed. Results: Fatigue scores were highest at 6 weeks after radiotherapy. Therefore fatigue at week 6 was defined as the primarily endpoint. In the univariate analysis, a significant association was found between different dosimetric variables, chemotherapy, T- and N-stage, baseline fatigue and fatigue at week 6. In the multivariate linear regression analysis, the final model included the minimal dose to the brainstem (p=0,03), baseline fatigue (p<0,001) and the combination of radiotherapy and chemotherapy (p=0,01). As secondary endpoint, the difference score between fatigue at week 6 and baseline fatigue was analyzed. In the multivariate analysis, a significant association was found between the variables minimal dose in the brainstem (p=0,043) and chemotherapy (p=0,040) with the difference score for fatigue at 6 weeks In the multivariate logistic regression analysis no association was found between dosimetric data and fatigue at 6 weeks when dichotomized between no-minimal fatigue and moderate –severe fatigue. Conclusion: A significant association was found between the minimal dose to the brainstem and fatigue 6 weeks after completion of treatment. In some individual patients, reduction of the minimal dose to the brainstem is expected to decrease fatigue after radiotherapy.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Langendijk, Prof. dr. J.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1820 |
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