Temporal Patterns of Fatigue Predict Pathologic Response in Patients Treated With Preoperative Chemoradiation Therapy for Rectal Cancer

Journal Article · Sun Nov 01 04:00:00 EST 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.11.027· OSTI ID:21362214

Park, Hee Chul; Janjan, Nora A ^[1]; Mendoza, Tito R ^[2]; Lin, Edward H ^[3]; Vadhan-Raj, Saroj ^[4]; Hundal, Mandeep ^[1]; Yiqun, Zhang ^[2]; Delclos, Marc E; Crane, Christopher H; Das, Prajnan ^[1]; Wang, Xin Shelley; Cleeland, Charles S ^[2]; Krishnan, Sunil ^[1]

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1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
2. Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
3. Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
4. Department of Cytokine Therapy and Supportive Care, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

Purpose: To investigate whether symptom burden before and during preoperative chemoradiation therapy (CRT) for rectal cancer predicts for pathologic tumor response. Methods and Materials: Fifty-four patients with T3/T4/N+ rectal cancers were treated on a Phase II trial using preoperative capecitabine and concomitant boost radiotherapy. Symptom burden was prospectively assessed before (baseline) and weekly during CRT by patient self-reported questionnaires, the MD Anderson Symptom Inventory (MDASI), and Brief Fatigue Inventory (BFI). Survival probabilities were estimated using the Kaplan-Meier method. Symptom scores according to tumor downstaging (TDS) were compared using Student's t tests. Logistic regression was used to determine whether symptom burden levels predicted for TDS. Lowess curves were plotted for symptom burden across time. Results: Among 51 patients evaluated for pathologic response, 26 patients (51%) had TDS. Fatigue, pain, and drowsiness were the most common symptoms. All symptoms increased progressively during treatment. Patients with TDS had lower MDASI fatigue scores at baseline and at completion (Week 5) of CRT (p = 0.03 for both) and lower levels of BFI 'usual fatigue' at baseline. Conclusion: Lower levels of fatigue at baseline and completion of CRT were significant predictors of pathologic tumor response gauged by TDS, suggesting that symptom burden may be a surrogate for tumor burden. The relationship between symptom burden and circulating cytokines merits evaluation to characterize the molecular basis of this phenomenon.

• OSTI ID: 21362214
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 75; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
COMBINED THERAPY
DIGESTIVE SYSTEM
DISEASES
FATIGUE
GASTROINTESTINAL TRACT
INTESTINES
LARGE INTESTINE
MECHANICAL PROPERTIES
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
PAIN
RADIOLOGY
RADIOTHERAPY
RECTUM
SYMPTOMS
THERAPY