Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.
J Cancer Res Clin Oncol. 2023 Sep;149(12):9891-9901. doi: 10.1007/s00432-023-04857-1. Epub 2023 May 30.
The aims of this study were to evaluate long-term multidimensional fatigue in patients with brain metastases (BM) up to 21 months after Gamma Knife radiosurgery (GKRS) and (change in) fatigue as predictor of survival.
Patients with 1 to 10 BM, expected survival > 3 months, and Karnofsky Performance Status ≥ 70, and Dutch non-cancer controls were included. Fatigue was measured with the Multidimensional Fatigue Inventory. Levels of fatigue between patients and controls were compared using independent-samples t-tests. Linear mixed models were used to evaluate fatigue within the patient group up to 21 months after GKRS. Pre-GKRS fatigue and minimal clinically important (MCI) changes in fatigue in the first three months (defined as a 2-point difference) after GKRS were evaluated as predictors of survival time.
Prior to GKRS, patients with BM (n = 92) experienced significantly higher fatigue on all subscales than controls (n = 104). Over 21 months, physical fatigue increased, and mental fatigue decreased significantly. More specifically, general, and physical fatigue increased significantly between pre-GKRS and 3 months, followed by stable scores between 3 (n = 67) and 6 (n = 53), 6 and 12 (n = 34) and 12 and 21 (n = 21) months. An MCI increase in general or physical fatigue over the first 3 months after GKRS was a significant predictor of shorter survival time.
Except for mental fatigue, all aspects of fatigue remained elevated or further increased up to 21 months after treatment. Furthermore, an increase in general or physical fatigue within three months after GKRS may be a prognostic indicator for poorer survival.
NCT02953756, November 3, 2016.
本研究旨在评估脑转移瘤（BM）患者在伽玛刀放射外科治疗（GKRS）后 21 个月的长期多维疲劳，并探讨疲劳变化作为生存预测指标。
纳入 1-10 个 BM、预期生存时间>3 个月、Karnofsky 表现状态≥70 分的患者，以及荷兰非癌症对照者。采用多维疲劳量表评估疲劳。采用独立样本 t 检验比较患者与对照组之间的疲劳水平。采用线性混合模型评估 GKRS 后 21 个月内患者组的疲劳情况。在 GKRS 前的疲劳和 GKRS 后前 3 个月（定义为 2 分差异）的最小临床重要变化（MCI）作为生存时间的预测指标。
在 GKRS 前，BM 患者（n=92）在所有子量表上的疲劳程度均显著高于对照组（n=104）。在 21 个月的随访期间，体力疲劳增加，而脑力疲劳显著下降。更具体地说，一般疲劳和体力疲劳在 GKRS 前和 3 个月之间显著增加，随后在 3 个月（n=67）和 6 个月（n=53）、6 个月（n=34）和 12 个月（n=34）、12 个月（n=21）和 21 个月（n=21）之间稳定。GKRS 后前 3 个月一般或体力疲劳的 MCI 增加是生存时间较短的显著预测指标。
除了脑力疲劳外，治疗后 21 个月内所有疲劳方面仍保持升高或进一步增加。此外，GKRS 后 3 个月内一般或体力疲劳的增加可能是预后不良的预测指标。
NCT02953756，2016 年 11 月 3 日。
