title: Exploring a link between fatigue and intestinal injury during pelvic radiotherapy.
abstract: 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.
authors.affiliation: Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden. sofie.jakobsson@fhs.gu.se
authors.forename: Sofie
authors.initials: S
authors.lastname: Jakobsson
authors.forename: Karin
authors.initials: K
authors.lastname: Ahlberg
authors.forename: Charles
authors.initials: C
authors.lastname: Taft
authors.forename: Tor
authors.initials: T
authors.lastname: Ekman
mesh_terms: 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*
chemical_list: D009961:Orosomucoid; D002956:Citrulline; D002097:C-Reactive Protein