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Compromised quality of life in adult patients who have received a radiation dose towards the basal part of the brain. A case-control study in long-term survivors from cancer in the head and neck region

Elisabet Löfdahl1, Gertrud Berg1, Karl-Axel Johansson2, Maria Leonsson Zachrisson3, Helge Malmgren4, Claes Mercke1, Erik Olsson5, Lena Wiren3 and Gudmundur Johannsson3*

Author Affiliations

1 Departments of Oncology, Gothenburg, Sweden

2 Departments Radiation Physics, Gothenburg, Sweden

3 Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Grona straket 8, SE-413 45, Gothenburg, Sweden

4 Department of Philosophy, Linguistics and Theory of Science, Gothenburg, Sweden

5 Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy and University of Gothenburg, Gothenburg, Sweden

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Radiation Oncology 2012, 7:179  doi:10.1186/1748-717X-7-179

Published: 29 October 2012

Abstract

Background

Adult patients with hypothalamic-pituitary disorders have compromised quality of life (QoL). Whether this is due to their endocrine consequences (hypopituitarism), their underlying hypothalamic-pituitary disorder or both is still under debate. The aim of this trial was to measure quality of life (QoL) in long-term cancer survivors who have received a radiation dose to the basal part of the brain and the pituitary.

Methods

Consecutive patients (n=101) treated for oropharyngeal or epipharyngeal cancer with radiotherapy followed free of cancer for a period of 4 to10 years were identified. Fifteen patients (median age 56 years) with no concomitant illness and no hypopituitarism after careful endocrine evaluation were included in a case-control study with matched healthy controls. Doses to the hypothalamic-pituitary region were calculated. QoL was assessed using the Symptom check list (SCL)-90, Nottingham Health Profile (NHP), and Psychological Well Being (PGWB) questionnaires. Level of physical activity was assessed using the Baecke questionnaire.

Results

The median accumulated dose was 1.9 Gy (1.5–2.2 Gy) to the hypothalamus and 2.4 Gy (1.8–3.3 Gy) to the pituitary gland in patients with oropharyngeal cancer and 6.0–9.3 Gy and 33.5–46.1 Gy, respectively in patients with epipharyngeal cancer (n=2). The patients showed significantly more anxiety and depressiveness, and lower vitality, than their matched controls.

Conclusion

In a group of long time survivors of head and neck cancer who hade received a low radiation dose to the hypothalamic-pituitary region and who had no endocrine consequences of disease or its treatment QoL was compromised as compared with well matched healthy controls.

Keywords:
Growth hormone; Head-and-neck cancer; Quality of life; CNS; Low-dose-radiation; Long-term survivors