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Quality of life for head and neck cancer patients treated by combined modality therapy: the therapeutic benefit of technological advances in radiotherapy

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Abstract

Purpose

To evaluate quality of life (QoL) in patients with head and neck squamous cell carcinoma (HNSCC) treated by combined modality therapy, with a focus on the therapeutic benefits of QoL that result from technological advances in radiotherapy (RT).

Methods

A cross-sectional survey of QoL using the EORTC QLQ-C30 and QLQ-H&N35 questionnaires was performed for 307 HNSCC survivors. One hundred and thirty-five patients were treated by two-dimensional RT (2DRT), 90 by three-dimensional conformal RT (3DCRT), and 82 by intensity-modulated RT (IMRT). The effect size between groups was calculated using Cohen’s D coefficient.

Results

Those who had a higher annual family income or were treated by more advanced RT techniques had better QoL outcomes. Compared with 2DRT, the impact of 3DCRT was small (Cohen’s D: 0.02–0.40) on all QoL scales. For IMRT, the impact was small on most scales and moderate (Cohen’s D: 0.55–0.60) on opening mouth, dry mouth, and sticky saliva. Compared with 3DCRT, the impact of IMRT was small (Cohen’s D: 0.03–0.29) on all scales.

Conclusion

Advances in RT provided a positive effect on QoL outcome, especially on swallowing-related QoL scales, for patients with HNSCC treated by combined modality therapy.

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Abbreviations

EORTC:

European Organization of Research and Treatment of Cancer

3DCRT:

Three-dimensional conformal radiotherapy

IMRT:

Intensity-modulated radiotherapy

References

  1. Annual report of Taiwan cancer incidence and mortality rates. (1997). Department of Health, Taiwan Provincial Government, Taipei, Taiwan.

  2. Amdur, R., Parsons, J., Mendenhall, W., Million, R., Stringer, S., & Cassisi, N. (1989). Postoperative irradiation for squamous cell carcinoma of the head and neck: an analysis of treatment results and complications. International Journal of Radiation Oncology, Biology, Physics, 16(1), 25–36.

    CAS  PubMed  Google Scholar 

  3. Peters, L., Goepfert, H., Ang, K., Byers, R., Maor, M., Guillamondegui, O., et al. (1993). Evaluation of the dose for postoperative radiation therapy of head and neck cancer: First report of a prospective randomized trial. International Journal of Radiation Oncology, Biology, Physics, 26(1), 3–11.

    CAS  PubMed  Google Scholar 

  4. Teo, P., Ma, B., & Chan, A. (2004). Radiotherapy for nasopharyngeal carcinoma: Transition from two-dimensional to three-dimensional methods. Radiotherapy & Oncology, 73(2), 163–172.

    Article  Google Scholar 

  5. Chao, K., Majhail, N., Huang, C., Simpson, J., Perez, C., Haughey, B., et al. (2001). Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: A comparison with conventional techniques. Radiotherapy & Oncology, 61(3), 275–280.

    Article  CAS  Google Scholar 

  6. Jen, Y., Shih, R., Lin, Y., Su, W., Ku, C., Chang, C., et al. (2005). Parotid gland-sparing 3-dimensional conformal radiotherapy results in less severe dry mouth in nasopharyngeal cancer patients: A dosimetric and clinical comparison with conventional radiotherapy. Radiotherapy & Oncology, 75(2), 204–209.

    Article  Google Scholar 

  7. Lee, N., Xia, P., Quivey, J., Sultanem, K., Poon, I., Akazawa, C., et al. (2002). Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: An update of the UCSF experience. International Journal of Radiation Oncology, Biology, Physics, 53(1), 12–22.

    PubMed  Google Scholar 

  8. Wolden, S., Chen, W., Pfister, D., Kraus, D., Berry, S., & Zelefsky, M. (2006). Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience. International Journal of Radiation Oncology, Biology, Physics, 64(1), 57–62.

    PubMed  Google Scholar 

  9. Charlson, M., Pompei, P., Ales, K., & MacKenzie, C. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.

    Article  CAS  PubMed  Google Scholar 

  10. Fang, F., Leung, S., Huang, C., Liu, Y., Wang, C., Chen, H., et al. (1997). Combined-modality therapy for squamous carcinoma of the buccal mucosa: Treatment results and prognostic factors. Head and Neck, 19(6), 506–512.

    Article  CAS  PubMed  Google Scholar 

  11. Aaronson, N., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N., et al. (1993). The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376.

    Article  CAS  PubMed  Google Scholar 

  12. Bjordal, K., Hammerlid, E., Ahlner-Elmqvist, M., de Graeff, A., Boysen, M., Evensen, J., et al. (1999). Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. Journal of Clinical Oncology, 17(3), 1008–1019.

    CAS  PubMed  Google Scholar 

  13. Fayers, P., Aaronson, K., & Bjordal, K. (2002). EORTC QLQ-C30 scoring manual (2nd ed.). Brussels, Belgium: EORTC Data Center, 1999.

    Google Scholar 

  14. Langendijk, J., Doornaert, P., Verdonck-de Leeuw, I., Leemans, C., Aaronson, N., & Slotman, B. (2008). Impact of treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. Journal of Clinical Oncology, 26(22), 3770–3776.

    Article  PubMed  Google Scholar 

  15. Cohen, J. (2007). Statistcial power analysis for the behavioral sciences (2nd ed.). NJ, Erlbaum: Hillsdale.

    Google Scholar 

  16. Middel, B., Stewart, R., Bouma, J., Sonderen, E., & van den Heuvel, W. (2001). How to validate clinically important change in health-related functional status. Is the magnitude of the effect size consistently related to magnitude of change as indicated by global question rating. Journal of Evaluation in Clinical Practice, 7(4), 399–410.

    Article  CAS  PubMed  Google Scholar 

  17. Osoba, D., Rodrigues, G., Myles, J., Zee, B., & Pater, J. (1998). Interpreting the significance of changes in health-related quality-of-life scores. Journal of Clinical Oncology, 16(1), 139–144.

    CAS  PubMed  Google Scholar 

  18. Fang, F., Chiu, H., Kuo, W., Wang, C., Leung, S., Chen, H., et al. (2002). Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment. International Journal of Radiation Oncology, Biology, Physics, 53(4), 959–968.

    PubMed  Google Scholar 

  19. Fang, F., Tsai, W., Chien, C., Chiu, H., & Wang, C. (2004). Health-related quality of life outcome for oral cancer survivors after surgery and postoperative radiotherapy. Japanese Journal of Clinical Oncology, 34(11), 641–646.

    Article  PubMed  Google Scholar 

  20. Chie, W., Hong, R., Lai, C., Ting, L., & Hsu, M. (2003). Quality of life in patients of nasopharyngeal carcinoma: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35. Quality of Life Research, 12(1), 93–98.

    Article  CAS  PubMed  Google Scholar 

  21. Adler, N., Boyce, W., Chesney, M., Folkman, S., & Syme, S. (1993). Socieconomic inequalities in health: No easy solution. The Journal of the American Medical Association, 269(24), 3140–3145.

    Article  CAS  Google Scholar 

  22. Penson, D., Stoddard, M., Pasta, D., Lubeck, D., Flanders, S., & Litwin, M. (2001). The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer. Journal of Clinical Epidemiology, 54(4), 350–358.

    Article  CAS  PubMed  Google Scholar 

  23. Dijkema, T., Terhaard, C., Roesink, J., Braam, P., van Gils, C., Moerland, M., et al. (2008). Large cohort dose-volume response analysis of parotid gland function after radiotherapy: Intensity-modulated versus conventional radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 72(4), 1101–1109.

    PubMed  Google Scholar 

  24. Vergeer, M., Doornaert, P., Rietveld, D., Leemans, C., Slotman, B., & Langendijk, J. (2009). Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: Results of a nonrandomized prospective study using a standardized follow-up program. International Journal of Radiation Oncology, Biology, Physics, 74(1), 1–8.

    PubMed  Google Scholar 

  25. Huguenin, P., Taussky, D., Moe, K., Meister, A., Baumert, B., Lutolf, U., et al. (1999). Quality of life in patients cured from a carcinoma of the head and neck by radiotherapy: The importance of the target volume. International Journal of Radiation Oncology, Biology, Physics, 45(1), 47–52.

    CAS  PubMed  Google Scholar 

  26. Hammerlid, E., & Taft, C. (2001). Health-related quality of life in long-term head and neck cancer survivors: A comparison with general population norms. British Journal of Cancer, 84(2), 149–156.

    Article  CAS  PubMed  Google Scholar 

  27. Levendag, P., Teguh, D., Voet, P., van der Est, H., Noever, I., de Kruijf, W. J., et al. (2007). Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship. Radiotherapy & Oncology, 85(1), 64–73.

    Article  Google Scholar 

  28. Teguh, D., Levendag, P., Noever, I., van Rooij, P., Voet, P., van der Est, H., et al. (2008). Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx. International Journal of Radiation Oncology, Biology, Physics, 72(4), 1119–1127.

    PubMed  Google Scholar 

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Acknowledgments

Supported by grant “CMRPG860501” and “CMRPG860502” from the Chang Gung Memorial Hospital, Taiwan.

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No actual or potential conflict of interest exists.

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Correspondence to Fu-Min Fang.

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Huang, TL., Tsai, WL., Chien, CY. et al. Quality of life for head and neck cancer patients treated by combined modality therapy: the therapeutic benefit of technological advances in radiotherapy. Qual Life Res 19, 1243–1254 (2010). https://doi.org/10.1007/s11136-010-9688-3

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  • DOI: https://doi.org/10.1007/s11136-010-9688-3

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