title: Fatigue during chemoradiotherapy for nasopharyngeal cancer and its relationship to radiation dose distribution in the brain.
abstract: OBJECTIVE
  Fatigue during head and neck radiotherapy may be related to radiation dose to the central nervous system (CNS). The impact of patient, tumour, and dosimetric variables on acute fatigue was assessed in nasopharyngeal cancer patients undergoing chemoradiotherapy.
  
  
  METHODS
  Radiation dose to the following retrospectively-delineated CNS structures; brainstem, cerebellum, pituitary gland, pineal gland, hypothalamus, hippocampus and basal ganglia (BG) and clinical variables were related to incidence of ⩾ grade 2 fatigue in 40 patients.
  
  
  RESULTS
  Sixty per cent of patients reported fatigue during and following radiotherapy. Dmean and D2 to the BG and Dmean to the pituitary gland were significantly associated with fatigue during radiation (P<0.01). Dmean to the cerebellum was associated with fatigue following radiotherapy and at any time (P < 0.01). After adjusting for clinical factors, an association remained between fatigue during radiotherapy and mean dose and D2 to the pituitary gland and BG (P = 0.012, 0.036, 0.009 and 0.018) and mean dose to the cerebellum following radiation and at any time (P = 0.042 and 0.029).
  
  
  CONCLUSIONS
  Disruption of connections between BG, cerebellum, and higher cortical centres or disruption of pituitary-regulated hormonal balance may be implicated in the pathophysiology of radiation-related fatigue.
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK.
authors: Ceri
authors: C
authors: Powell
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors: Ulrike
authors: U
authors: Schick
authors: Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, Surrey, UK.
authors: James P
authors: JP
authors: Morden
authors: Joint Department of Physics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
authors: Sarah L
authors: SL
authors: Gulliford
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK.
authors: Aisha B
authors: AB
authors: Miah
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors: Shreerang
authors: S
authors: Bhide
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK.
authors: Kate
authors: K
authors: Newbold
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors: Kevin J
authors: KJ
authors: Harrington
authors: Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK. Electronic address: chris.nutting@rmh.nhs.uk.
authors: Chris M
authors: CM
authors: Nutting
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000528:radiation effects*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000628:therapy*; D011829:Radiation Dosage; D012189:Retrospective Studies
keywords: CNS; Chemoradiotherapy; Fatigue; IMRT; Nasopharyngeal cancer; Radiotherapy