Abstract
Introduction: Fatigue has always been a distressing symptom for patients of head and neck cancer (HNC) on radiotherapy. Although modern technologies like intensity modulated radiotherapy (IMRT) have been instrumental in reducing many of the distressing side-effects but the recent observation of increased fatigue has been a concern. Recent publications though very few hinted at possible correlation with dosage to central nervous system (CNS) structures. The current resource review highlights a very preliminary example of a futuristic approach. Materials and Methods: This retrospective analysis comprising of 20 HNC patients receiving either postoperative or radical radiotherapy by IMRT were evaluated with CNS dosage. The main organs contoured in planning computed tomography (CT) scan were brainstem (BS) and posterior fossa (PF) excluding BS. The dose received to these organs was recorded. The literature reported CNS structure dosage, which can probably cause increased fatigue was assessed. Results: Among the 20 nonnasopharyngeal HNC, 13 received radical radiotherapy and 7 had postoperative radiotherapy. Six patients had treatment gap varying between 2 and 10 days, mostly due to hematological toxicities and oral mucositis. The median volumes of PF and BS were 263.5 and 25.1 cc. Dmax for BS and PF ranged between 4.8 and 44.76 Gy and 23.8-63.2 Gy and the median Dmean for PF was 8.89 Gy. Conclusion: Future prospective analysis with inclusion of modified brief fatigue inventory scale and dosimetric evaluation of CNS structures would probably answer the necessity of sparing CNS structures and spare patients from excessive fatigue and related consequences.
Published Version
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