A prospective study on association of fatigue with dose to central nervous system structures in head and neck irradiation

Background: Fatigue is a common symptom in cancer patients accounting for 50–80% of patients and is multifactorial . Although many studies have focused on fatigue in head and neck cancer patients, studies on radiation dosimetric analysis of central nervous system (CNS) structures and their association with fatigue are rare. Hence, we have assessed patient-reported acute fatigue scores and correlated them with radiation dose received by brainstem, posterior fossa and pituitary. Materials and methods : Forty-two head and neck cancer patients receiving radiotherapy from October 2018 to March 2020 were analyzed for fatigue scores using a questionnaire. Posterior Fossa, Pituitary and Brainstem structures were delineated and dose received by them was correlated with fatigue scores. Results: Fatigue scores increased from 49 ± 12 at baseline to 78 ± 12 at the 6 th week of radiation treatment and reduced to 56 ± 18 at one month post treatment, but did not reach pre-treatment values. A statistically significant correlation was observed between posterior fossa D max and 6 th week fatigue scores; and brainstem D max and fatigue scores at one month post treatment. Conclusion : Doses to brainstem and posterior fossa should be assessed and kept as low as reasonably possible to minimize fatigue.