背景:根治性放疗(RT)是头颈部(H&N)癌症治疗的基石,但它通常会由于大脑结构的照射而导致疲劳,影响患者生活质量。
目的:本研究旨在系统地研究脑结构中H&NRT后疲劳的剂量相关性。
方法:系统评价包括研究了在不同时间间隔接受RT的H&N癌症患者的疲劳结果与大脑结构之间的相关性。PubMed,Scopus,和WOS数据库用于系统评价。按照PRISMA指南对纳入研究进行方法学质量评估。RT之后,分析了H&N癌症患者队列与脑结构和亚结构的剂量相关性,比如后颅窝,脑干,小脑,脑垂体,髓质,和基底神经节.
结果:在检索中确定了13项符合纳入标准的研究。这些研究评估了疲劳与H&NRT后的RT剂量之间的相关性。RT剂量范围为40Gy至70Gy。大多数研究表明疲劳轨迹与剂量效应之间存在相关性,与增加剂量相关的更高水平的疲劳。此外,五项研究发现,急性和晚期疲劳与特定大脑结构的剂量有关,比如脑干,后颅窝,小脑,脑垂体,海马体,和基底神经节.
结论:H&NRT患者的疲劳与特定大脑区域接受的辐射剂量有关,特别是在后窝,脑干,小脑,脑垂体,髓质,和基底神经节.这些区域的剂量减少可能有助于缓解疲劳。监测放疗后高危患者的疲劳可能是有益的,特别是对于那些经历晚期疲劳的人。
BACKGROUND: Radical
radiotherapy (RT) is the cornerstone of Head and Neck (H&N) cancer treatment, but it often leads to fatigue due to irradiation of brain structures, impacting patient quality of life.
OBJECTIVE: This study aimed to systematically investigate the dose correlates of fatigue after H&N RT in brain structures.
METHODS: The systematic
review included studies that examined the correlation between fatigue outcomes in H&N cancer patients undergoing RT at different time intervals and brain structures. PubMed, Scopus, and WOS databases were used in the systematic
review. A methodological quality assessment of the included studies was conducted following the PRISMA guidelines. After RT, the cohort of H&N cancer patients was analyzed for dose correlations with brain structures and substructures, such as the posterior fossa, brainstem, cerebellum, pituitary gland, medulla, and basal ganglia.
RESULTS: Thirteen studies meeting the inclusion criteria were identified in the search. These studies evaluated the correlation between fatigue and RT dose following H&N RT. The RT dose ranged from 40 Gy to 70 Gy. Most of the studies indicated a correlation between the trajectory of fatigue and the dose effect, with higher levels of fatigue associated with increasing doses. Furthermore, five studies found that acute and late fatigue was associated with dose volume in specific brain structures, such as the brain stem, posterior fossa, cerebellum, pituitary gland, hippocampus, and basal ganglia.
CONCLUSIONS: Fatigue in H&N RT patients is related to the radiation dose received in specific brain areas, particularly in the posterior fossa, brain stem, cerebellum, pituitary gland, medulla, and basal ganglia. Dose reduction in these areas may help alleviate fatigue. Monitoring fatigue in high-risk patients after radiation therapy could be beneficial, especially for those experiencing late fatigue.