Exploring a link between fatigue and intestinal injury during pelvic radiotherapy.
BACKGROUND
The association between cancer-related fatigue and pathological processes in the body is largely unknown. This study was designed to investigate a possible linkage between fatigue and intestinal injury during pelvic radiotherapy.


METHODS
Twenty-nine women undergoing pelvic radiotherapy for anal or uterine cancer were prospectively followed. Fatigue and diarrhea were assessed using patient self-reported questionnaires. Plasma citrulline concentration, as a sign of intestinal injury, and C-reactive protein, orosomucoid, albumin, α(1)-antitrypsin, and haptoglobin, as signs of systemic inflammation, were analyzed.


RESULTS
Fatigue increased significantly (p < .001) and citrulline decreased significantly (p < .001) during treatment. A significant negative correlation (r = -0.40; p < .05) was found between fatigue and epithelial atrophy in the intestine (as assessed by plasma citrulline) after 3 weeks of treatment and a significant positive correlation (r = 0.75; p < .001) was found between fatigue and diarrhea. Signs of systemic inflammation were evident, with significant increases in serum orosomucoid, serum haptoglobin (p < .05) and serum α(1)-antitrypsin (p < .001) and a significant decrease in serum albumin (p < .001).


CONCLUSIONS
The present study indicates a link between fatigue and intestinal injury during pelvic radiotherapy. This observation should be considered as a preliminary finding because of the small sample size but may serve as a rationale for therapeutic interventions aimed at alleviating both fatigue and gastrointestinal symptoms during pelvic radiotherapy.
Jakobsson
Sofie
S
Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden. sofie.jakobsson@fhs.gu.se
Ahlberg
Karin
K
Taft
Charles
C
Ekman
Tor
T
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002956:Citrulline / Q000097:blood; D003967:Diarrhea / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D007422:Intestines / Q000528:radiation effects*; D008875:Middle Aged; D009961:Orosomucoid / Q000032:analysis; D010388:Pelvis / Q000528:radiation effects*; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000532:radiotherapy*
D009961:Orosomucoid; D002956:Citrulline; D002097:C-Reactive Protein