Article

Temporal patterns of fatigue predict pathologic response in patients treated with preoperative chemoradiation therapy for rectal cancer.

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
International journal of radiation oncology, biology, physics (impact factor: 4.59). 03/2009; 75(3):775-81. DOI:10.1016/j.ijrobp.2008.11.027 pp.775-81
Source: PubMed

ABSTRACT To investigate whether symptom burden before and during preoperative chemoradiation therapy (CRT) for rectal cancer predicts for pathologic tumor response.
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.
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.
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.

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  • Article: Prognostic factors in patients with unresectable locally advanced pancreatic adenocarcinoma treated with chemoradiation
    Sunil Krishnan MD, Vishal Rana MD, MPSA Nora A. Janjan MD, James L. Abbruzzese MD, Morris S. Gould MPAS, Prajnan Das MD, MS, MPH, Marc E. Delclos MD, Shana Palla MS, PhD Sushovan Guha MD, Gauri Varadhachary MD, [......], James L. Abbruzzese, Morris S. Gould, Prajnan Das, Marc E. Delclos, Shana Palla, Sushovan Guha, Gauri Varadhachary, Douglas B. Evans, Robert A. Wolff, Christopher H. Crane
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    Cancer 11/2006; 107(11):2589 - 2596. · 4.77 Impact Factor
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Keywords

Brief Fatigue Inventory
 
common symptoms
 
cytokines merits evaluation
 
MD Anderson Symptom Inventory
 
pathologic response
 
pathologic tumor response
 
pathologic tumor response gauged
 
patient self-reported questionnaires
 
Phase II trial
 
preoperative chemoradiation therapy
 
Student's t tests
 
Symptom burden
 
symptom burden levels
 
Symptom scores
 
symptoms
 
T3/T4/N+ rectal cancers
 
tumor burden
 
tumor downstaging
 
usual fatigue
 
Week 5
 

Hee Chul Park