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@ARTICLE{Schmidt:130504,
      author       = {M. Schmidt$^*$ and A. Meynköhn$^*$ and N. Habermann$^*$
                      and J. Wiskemann$^*$ and J. Oelmann and H. Hof and S.
                      Wessels and O. Klassen$^*$ and J. Debus and K. Potthoff$^*$
                      and K. Steindorf$^*$ and C. M. Ulrich$^*$},
      title        = {{R}esistance {E}xercise and {I}nflammation in {B}reast
                      {C}ancer {P}atients {U}ndergoing {A}djuvant {R}adiation
                      {T}herapy: {M}ediation {A}nalysis {F}rom a {R}andomized,
                      {C}ontrolled {I}ntervention {T}rial.},
      journal      = {International journal of radiation oncology, biology,
                      physics},
      volume       = {94},
      number       = {2},
      issn         = {0360-3016},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2017-05583},
      pages        = {329 - 337},
      year         = {2016},
      abstract     = {To explore the mediating role of inflammatory parameters in
                      the development of fatigue, pain, and potentially related
                      depressive symptoms during radiation therapy for breast
                      cancer and its mitigation by resistance exercise.Breast
                      cancer patients scheduled for adjuvant radiation therapy
                      were randomized to 12-week progressive resistance exercise
                      training (EX) or a relaxation control group. Interleukin-6
                      (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were
                      measured in serum samples collected before, at the end, and
                      6 weeks after radiation therapy from 103 chemotherapy-naïve
                      participants. Fatigue was assessed with the multidimensional
                      Fatigue Assessment Questionnaire, pain with the European
                      Organization for Research and Treatment of Cancer QLQ-C30,
                      and depressive symptoms with the Center for Epidemiologic
                      Studies Depression Scale. Analysis of covariance models,
                      partial correlations, Freedman-Schatzkin tests, and R(2)
                      effect-size measures for mediation were calculated.The
                      analysis of covariance models revealed a significant
                      intervention effect on IL-6 (P=.010) and the IL-6/IL-1ra
                      ratio (P=.018), characterized by a marked increase during
                      radiation therapy among controls, but no significant change
                      in EX. Interleukin-1 receptor antagonist did not change
                      significantly in either group (P=.88). Increased IL-6 and
                      IL-6/IL-1ra levels at the end of radiation therapy were
                      significantly associated with increased physical fatigue and
                      pain 6 weeks after radiation. We observed significant
                      partial mediation by IL-6 and IL-6/IL-1ra of the effect of
                      resistance exercise on physical fatigue (Freedman-Schatzkin
                      P=.023 and P<.001) and pain (both P<.001). Hereby IL-6 and
                      IL-6/IL-1ra mediated between $15\%$ and $24\%$ of the
                      variance of physical fatigue and pain explained by the
                      intervention.This randomized, controlled trial showed a
                      significantly increased proinflammatory cytokine level after
                      adjuvant radiation therapy in breast cancer patients. This
                      effect was counteracted by progressive resistance exercise
                      training. Interleukin-6 and the IL-6/IL-1ra ratio seemed to
                      mediate the beneficial effect of exercise on physical
                      fatigue and pain but only to a small extent.},
      keywords     = {Interleukin-6 (NLM Chemicals) / Receptors, Interleukin-1
                      Type I (NLM Chemicals)},
      cin          = {G111 / G110 / G210},
      ddc          = {610},
      cid          = {I:(DE-He78)G111-20160331 / I:(DE-He78)G110-20160331 /
                      I:(DE-He78)G210-20160331},
      pnm          = {317 - Translational cancer research (POF3-317)},
      pid          = {G:(DE-HGF)POF3-317},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:26853341},
      doi          = {10.1016/j.ijrobp.2015.10.058},
      url          = {https://inrepo02.dkfz.de/record/130504},
}