Patient Reported Outcomes/Quality of Life

PV QA 4 - Poster Viewing Q&A 4

TU_44_3750 - Fatigue following radiation therapy in nasopharyngeal cancer survivors: a dosimetric analysis incorporating patient report and observer rating

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Fatigue following radiation therapy in nasopharyngeal cancer survivors: a dosimetric analysis incorporating patient report and observer rating
M. Kamal1,2, D. I. Rosenthal1, A. D. Batra1, S. Volpe1,3, B. Elgohari1,4, R. P. Goepfert1, A. S. Garden1, K. A. Hutcheson1, J. Phan1, S. Eraj1, A. Dursteler1,5, B. Williams1, J. Smith1, J. Aymard6, J. Berends7, A. White1, C. E. Cardenas1, S. J. Frank1, W. H. Morrison1, E. M. Sturgis1, T. R. Mendoza1, A. S. Mohamed1,8, C. D. Fuller1,9, and G. B. Gunn1; 1The University of Texas MD Anderson Cancer Center, Houston, TX, 2Clinical Oncology and Nuclear Medicine Department, Ain Shams University, Cairo, Egypt, 3University of Milan, Department of Hemato-Oncology, Milan, Italy, 4Mansoura University, Mansoura, Egypt, 5McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 6Abilene Christian University, Houston, TX, 7The University of Texas Health Science Center San Antonio, San Antonio, TX, 8Clinical Oncology and Nuclear Medicine Department, Alexandria University, Alexandria, Egypt, 9University of Texas Graduate School of Biomedical Sciences, Houston, TX

Purpose/Objective(s): To identify fatigue-related regions of interest (ROIs) and explore the radiotherapy (RT) dose-fatigue relationship in nasopharyngeal cancer (NPC) survivors using patient report and observer rating.

Materials/Methods: Disease free (>6 months) NPC survivors were eligible for a patient-reported outcome study in which participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Fatigue was reported using the fatigue item of the MDASI-HN (MDASI-HN-F) and the corresponding CTC-AE v3.0 fatigue grades were extracted. Dose-volume histograms (DVHs) were generated for 10 fatigue-related ROIs (manually-segmented and MRI-defined): brainstem (BS), pituitary gland (PG), hypothalamus (HT), basal ganglia, internal capsule, pineal gland, sub-thalamic nuclei, thalamus, substantia nigra, and hippocampus (HC). Wilcoxon rank-sum test was used to compare the maximum (Dmax) and mean doses (Dmean) across patients with and without fatigue. Logistic regression models, that includes Dmean and Dmax, was utilized to determine the best candidate ROI predictors of fatigue. ROI dose thresholds relating fatigue to RT dose were determined using recursive partitioning analysis (RPA) of all dosimetric parameters in 1 Gy bin.

Results: 56 NPC patients were included. Median age was 52 years, 93% had received IMRT; median RT dose was 70 Gy. The median time from RT end to fatigue assessment was 17 months. 33 patients (59%) had grade ≥1 fatigue as rated by the CTC-AE. Of those, 19 (57%) exhibited moderate\severe grades (grade ≥ 2). Similarly, 30 patients (54%) reported MDASI-HN-F score of ≥1. Of those, 14 (47%) reported moderate\severe scores (score≥5). The mean MDASI-HN-F score was 2.5. A strong linear relationship between MDASI-HN-F scores and CTC-AE-assessed fatigue grades was found (ρ = 0.89, p <0.01). Dmax values for PG, BS, HC and HT were comparable in patients who reported fatigue per MDASI-HN-F vs. assessed by CTC-AE (54 vs. 54, 52 vs. 52, 42 vs. 42, and 31 vs. 33 respectively). Dmax and Dmean of the PG were significantly higher in patients who reported fatigue by MDASI-HN (p=0.001 and 0.02 respectively), likewise assessed by CTC-AE (p=0.02 and 0.01 respectively). After adjusting for clinical factors, a statistically significant association was maintained between the MDASI-HN-F score and Dmax of the PG (p < 0.01). Regression model of the Dmax and Dmean identified PG as best candidate ROI predictor of presence of fatigue per MDASI-HN-F (AUC=0.74 and 0.69 respectively) as well as per CTC-AE (AUC= 0.68 and 0.62 respectively). Likewise, a PG dose-volume threshold of V52 Gy ≥ 16% (Logworth 2.4, AUC 0.7) was identified, by RPA, to be the strongest dosimetric predictor of the presence of fatigue reported by MDASI-HN-F.

Conclusion: We demonstrated a dose-fatigue relationship for a series of ROIs in the intermediate-range dose (<30-50 Gy) in a NPC cohort. These results suggest that the PG, in particular, should be routinely contoured and constrained during plan optimization when feasible.

Author Disclosure: M. Kamal: None. D.I. Rosenthal: Advisory Board; BMS. A.D. Batra: None. B. Elgohari: Research Grant; Joint supervision program funded by the Egyptian government. R.P. Goepfert: None. A.S. Garden: None. K.A. Hutcheson: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research, NIH/National Cancer Institute (NCI) Small Grants Program for Cancer Research. J. Phan: None. A. Dursteler: None. J. Aymard: None. S.J. Frank: Research Grant; C4 Imaging, ELEKTA, U19. Founder and Director; C4 Imaging. Honoraria; ELEKTA, Varian Medican Systems, Inc. Advisory Board; Varian Medican Systems, Inc. Stock; C4 Imaging. Royalty; C4 Imaging. Patent/License Fees/Copyright; C4 Imaging. Chairman; American Brachytherapy Society. Director; C4 Imaging. Director-at-large; North America Skull Base Society. W.H. Morrison: Advisory Board; Regeneron. Stock; Merck, Baxter, Johnson and Johnson. Member; NCCN Nonmelanoma Skin and Merkel Cell Committees. A.S. Mohamed: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research, National Institutes of Health (NIH). C.D. Fuller: Research Grant; National Institutes of Health, National Science Foundation, Elekta AB. Grant funding; Elekta AB. Honoraria; Nederlandse Organisatie voor Wetenschappelijk Onde. Consultant; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Travel Expenses; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Reviewer; Radiological Society of North America. Associate Editor; Radiographics. Data Management Task Force Committee Member; MR-LinAc Consortium. Member; National Cancer Institute. Task Group Member; American Association of Physicists in Medicine. G.B. Gunn: Associate Medical Director; MD Anderson Cancer Center - Proton Therapy.

Send Email for Mona Kamal


Assets

TU_44_3750 - Fatigue following radiation therapy in nasopharyngeal cancer survivors: a dosimetric analysis incorporating patient report and observer rating



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Fatigue following radiation therapy in nasopharyngeal cancer survivors: a dosimetric analysis incorporating patient report and observer rating