Temporal patterns of fatigue predict pathologic response in patients treated with preoperative chemoradiation therapy for rectal cancer.
Temporal patterns of fatigue predict pathologic response in patients treated with preoperative chemoradiation therapy for rectal cancer.
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DOI：
10.1016/j.ijrobp.2008.11.027
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发表时间：
2009-11-01
影响因子：
7
通讯作者：
Krishnan, Sunil
中科院分区：
文献类型：
--
作者：
Park, Hee Chul;Janjan, Nora A.;Mendoza, Tito R.;Lin, Edward H.;Vadhan-Raj, Saroj;Hundal, Mandeep;Zhang, Yiqun;Delclos, Marc E.;Crane, Christopher H.;Das, Prajnan;Wang, Xin Shelley;Cleeland, Charles S.;Krishnan, Sunil
研究直肠癌术前放化疗（CRT）前和期间的症状负荷是否可预测病理肿瘤反应。54例T3/T4/N+直肠癌患者在II期试验中使用术前卡培他滨和伴随的加强放疗进行治疗。通过患者自报问卷、MD安德森症状量表（MDASI）和简明疲劳量表（BFI），在CRT前（基线）和CRT期间每周前瞻性评估症状负担。使用Kaplan-Meier方法估计生存概率。使用Students t检验比较根据肿瘤降级（TDS）的症状评分。Logistic回归用于确定症状负荷水平是否可预测TDS。绘制随时间变化的症状负荷Lowess曲线。在评价病理学缓解的51例患者中，26例患者（51%）患有TDS。疲劳、疼痛和嗜睡是最常见的症状。所有症状在治疗期间进行性加重。TDS患者在基线和CRT完成（第5周）时的MDASI疲劳评分较低（两者p=0.03），基线时BFI“日常疲劳”水平较低。基线和CRT完成时较低水平的疲劳是TDS测量的病理肿瘤缓解的显著预测因素，表明症状负荷可能是肿瘤负荷的替代指标。症状负荷和循环细胞因子之间的关系值得评价，以表征这种现象的分子基础。
To investigate whether symptom burden before and during preoperative chemoradiation therapy (CRT) for rectal cancer predicts for pathological 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 prior to (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 Kaplan-Meier's method. Symptom scores according to tumor downstaging (TDS) were compared using Students 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 pathological 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 pathological 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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影响因子：
50.5
作者：
Laurie, S. A.;Ding, K.;Seymour, L.
通讯作者：
Seymour, L.
影响因子：
45.3
作者：
Langendijk, JA;Aaronson, NK;Wouters, EFM
通讯作者：
Wouters, EFM
影响因子：
3.1
作者：
Henke, M;Sindlinger, F;Schumacher, M
通讯作者：
Schumacher, M
影响因子：
45.3
作者：
Leyland-Jones, B;Semiglazov, V;Vercammen, E
通讯作者：
Vercammen, E
影响因子：
3.8
作者：
Groenvold, Mogens;Petersen, Morten Aagaard;Mouridsen, Henning T.
通讯作者：
Mouridsen, Henning T.