title: Compromised quality of life in adult patients who have received a radiation dose towards the basal part of the brain. A case-control study in long-term survivors from cancer in the head and neck region.
abstract: BACKGROUND
  Adult patients with hypothalamic-pituitary disorders have compromised quality of life (QoL). Whether this is due to their endocrine consequences (hypopituitarism), their underlying hypothalamic-pituitary disorder or both is still under debate. The aim of this trial was to measure quality of life (QoL) in long-term cancer survivors who have received a radiation dose to the basal part of the brain and the pituitary.
  
  
  METHODS
  Consecutive patients (n=101) treated for oropharyngeal or epipharyngeal cancer with radiotherapy followed free of cancer for a period of 4 to10 years were identified. Fifteen patients (median age 56 years) with no concomitant illness and no hypopituitarism after careful endocrine evaluation were included in a case-control study with matched healthy controls. Doses to the hypothalamic-pituitary region were calculated. QoL was assessed using the Symptom check list (SCL)-90, Nottingham Health Profile (NHP), and Psychological Well Being (PGWB) questionnaires. Level of physical activity was assessed using the Baecke questionnaire.
  
  
  RESULTS
  The median accumulated dose was 1.9 Gy (1.5-2.2 Gy) to the hypothalamus and 2.4 Gy (1.8-3.3 Gy) to the pituitary gland in patients with oropharyngeal cancer and 6.0-9.3 Gy and 33.5-46.1 Gy, respectively in patients with epipharyngeal cancer (n=2). The patients showed significantly more anxiety and depressiveness, and lower vitality, than their matched controls.
  
  
  CONCLUSIONS
  In a group of long time survivors of head and neck cancer who hade received a low radiation dose to the hypothalamic-pituitary region and who had no endocrine consequences of disease or its treatment QoL was compromised as compared with well matched healthy controls.
authors.affiliation: Departments of Oncology, Gothenburg, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Löfdahl
authors.forename: Gertrud
authors.initials: G
authors.lastname: Berg
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.forename: Maria Leonsson
authors.initials: ML
authors.lastname: Zachrisson
authors.forename: Helge
authors.initials: H
authors.lastname: Malmgren
authors.forename: Claes
authors.initials: C
authors.lastname: Mercke
authors.forename: Erik
authors.initials: E
authors.lastname: Olsson
authors.forename: Lena
authors.initials: L
authors.lastname: Wiren
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D016022:Case-Control Studies; D003863:Depression / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D007031:Hypothalamus / Q000528:radiation effects*; D021621:Imaging, Three-Dimensional / Q000379:methods; D007899:Leisure Activities; D008137:Longitudinal Studies; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy; D010610:Pharyngeal Neoplasms / Q000532:radiotherapy*; D010902:Pituitary Gland / Q000528:radiation effects*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D011882:Radiotherapy, High-Energy; D013001:Somatoform Disorders / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D014057:Tomography, X-Ray Computed / Q000379:methods