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Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer

Results of a prospective study

Residuale Defizite in der Lebensqualität ein Jahr nach intensitätsmodulierter Strahlentherapie bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren

Ergebnisse einer prospektiven Studie

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Abstract

Purpose

Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes.

Patients and methods

A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6–8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT.

Results

Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05).

Conclusion

QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery.

Zusammenfassung

Hintergrund

Die Therapie von Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren (LFKHT) geht mit einschneidenden Veränderungen einher und beeinflusst die Lebensqualität (LQ) erheblich. Diese prospektive Studie untersucht die LQ während des ersten Jahres nach intensitätsmodulierter Strahlentherapie (IMRT) und hat Prädiktoren dieser Veränderungen herausgearbeitet, um Therapieergebnisse verbessern zu können.

Patienten und Methoden

Patienten mit LFKHT füllten Lebensqualitätsfragebögen der European Organisation for Research and Treatment of Cancer (EORTC) aus; Hauptfragebogen (QLQ-C30) und Kopf-Hals-Tumor-Fragebogen (QLQ-HN35) jeweils vor definitiver oder adjuvanter IMRT (t0), am Ende der IMRT (t1), nach weiteren 6–8 Wochen (t2), 6 Monaten (t3) und nach 1 Jahr (t4).

Ergebnisse

Insgesamt haben 111 Patienten zu allen fünf Zeitpunkten die Fragebögen ausgefüllt und wurden in die Studie eingeschlossen (Responserate t0: 99%; Ausfallrate t0–t4: 5 %). Während der IMRT verschlechterten sich alle Domänen der LQ und besserten sich langsam über das erste Folgejahr. Viele Lebensqualitätswerte kehrten zum Ausgangsniveau zurück, während Probleme mit Riechen und Schmecken, trockener Mund und klebriger Speichel problematisch blieben. Probleme mit klebrigem Speichel wurden von Patienten nach definitiver IMRT häufiger berichtet als von Patienten nach adjuvanter Therapie (F = 3,5; P = 0,05).

Schlussfolgerung

Nach einer IMRT dauert es bei Patienten mit Kopf-Hals-Tumoren bis zu 1 Jahr bis die LQ wieder ihr Ausgangsniveau erreicht; einige Domänen bleiben auch noch nach 1 Jahr darunter. Obwohl es Ziel der IMRT ist, Funktion und LQ zu erhalten, bleiben trockener Mund und klebriger Speichel teilweise als Langzeiteffekte bestehen, insbesondere bei Patienten nach primärer IMRT. Patienten sollten diesbezüglich vor Beginn der Therapie aufgeklärt werden, um ihnen Unzufriedenheit mit der Geschwindigkeit der Rekonvaleszenz zu ersparen.

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References

  1. Grégoire V, Lefebvre JL, Licitra L, Felip E, on behalf of the EHNS-ESMO-ESTRO Guidelines Working Group (2010) Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v184–v186

  2. National Comprehensive Cancer Network (2014) Clinical practice guidelines in oncology. Head and neck cancers version 2.2014. https://www.nccn.org/store/login/login.aspx?ReturnURL = http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 1 July 2014

  3. Trotti A, Pajak TF, Gwede CK, Paulus R, Cooper J, Forastiere A, Ridge JA, Watkins-Bruner D, Garden AS, Ang KK, Curran W (2007) TAME: development of a new method for summarising adverse events of cancer treatment by the Radiation Therapy Oncology Group. Lancet Oncol 8:613–624

    Article  PubMed  Google Scholar 

  4. Hörmann K, Sadick H (2013) Role of surgery in the management of head and neck cancer: a contemporary view of the data in the era of organ preservation. J Laryngol Otol 127:121–127

    Article  PubMed  Google Scholar 

  5. Bhide SA, Nutting CM (2010) Advances in radiotherapy for head and neck cancer. Oral Oncol 46:439–441

    Article  CAS  PubMed  Google Scholar 

  6. Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225

    PubMed  Google Scholar 

  7. Tribius S, Sommer J, Prosch C, Bajrovic A, Muenscher A, Blessmann M, Kruell A, Pertsen C, Todorovic M, Tennstedt P (2013) Xerostomia after radiotherapy. What matters—mean total dose or dose to each parotid gland. Strahlenther Onkol 189:216–222

    Article  CAS  PubMed  Google Scholar 

  8. Harari PM (2005) Promising new advances in head and neck radiotherapy. Ann Oncol 16 (Suppl 6):vi13–vi19

    PubMed  Google Scholar 

  9. Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W (2008) Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 9:367–375

    Article  PubMed  Google Scholar 

  10. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group 9501/Intergroup (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944

    Article  PubMed  Google Scholar 

  11. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for Research and Treatment of Cancer Trial 22931 (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952

    Article  CAS  PubMed  Google Scholar 

  12. Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ, Meyza JW, Brédart A, Söderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P, Bottomly A, Kaasa S (2000) A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H & N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer 36:1796–1807

    Article  CAS  PubMed  Google Scholar 

  13. King MT (1996) The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 5:555–567

    Article  CAS  PubMed  Google Scholar 

  14. Singer S, Wollbrück D, Wulke C et al (2009) Validation of the EORTC QLQ-C30 and EORTC QLQ-H & N35 in laryngeal cancer patients after surgery. Head Neck 31:64–76

    Article  PubMed  Google Scholar 

  15. Singer S, Arraras J, Chie WC, Fisher S, Galalae R, Hammerlid E, Nicolatou-Galitis O, Schmalz C, Verdonck-de Leeuw IM, Gamper E, Keszte J, Hofmeister D (2013) Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H & N35: a methodological review. Qual Life Res 22:1927–1941

    Article  PubMed  Google Scholar 

  16. Fayers PM, Aaronson NK, Bjordal K et al (2001) The EORTC QLQ-C30 Scoring Manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels

  17. Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, Leung WK (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66:981–991

    Article  PubMed  Google Scholar 

  18. Braam PM, Roesink JM, Raaijmakers CP, Busschers WB, Terhaard CH (2007) Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol 2:3

    Article  PubMed Central  PubMed  Google Scholar 

  19. Fang FM, Chien CY, Tsai WL, Chen HC, Hsu HC, Lui CC, Huang TL, Huang HY (2008) Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy—a longitudinal study. Int J Radiat Oncol Biol Phys 72:356–364

    Article  PubMed  Google Scholar 

  20. Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F, Jefferies SJ, Scrase C, Yap BK, A’Hern RP, Sydenham MA, Emson M, Hall E, PARSPORT trial management group (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136

    Article  PubMed Central  PubMed  Google Scholar 

  21. So WK, Chan RJ, Chan DN, Hughes BG, Chair SY, Choi KC, Chan CW (2012) Quality-of-life among head and neck cancer survivors at one year after treatment—a systematic review. Eur J Cancer:48:2391–2408

    Article  CAS  PubMed  Google Scholar 

  22. Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, Hammerlid E, Bjordal K (2005) Quality of life and head and neck cancer: a 5 year prospective study. Laryngoscope 115:2183–2192

    Article  PubMed  Google Scholar 

  23. Nordgren M, Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Jannert M (2008) Quality of life in oral carcinoma: a 5-year prospective study. Head Neck 30:461–470

    Article  PubMed  Google Scholar 

  24. Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, Witte BI, de Bree R, Doornaert P, Langendijk JA, Leemans CR (2013) Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 49:443–448

    Article  PubMed  Google Scholar 

  25. Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA, Eisbruch A (2003) Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol Biol Phys 57:61–70

    Article  PubMed  Google Scholar 

  26. Maurer J, Hipp M, Schäfer C, Kölbl O (2011) Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol 187:744–749

    Article  PubMed  Google Scholar 

  27. Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M, Murdoch-Kinch CA, Cornwall B, Lee CS, Chepeha DB, Eisbruch A (2013) Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 85:935–940

    Article  PubMed Central  PubMed  Google Scholar 

  28. Ringash J, Warde P, Lockwood G, O’Sullivan B, Waldron J, Cummings B (2005) Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia. Int J Radiat Oncol Biol Phys 61:1403–1407

    Article  PubMed  Google Scholar 

  29. Morton RP (2003) Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey. Laryngoscope 113:1091–1103

    Article  PubMed  Google Scholar 

  30. Voordeckers M, Everaert H, Tournel K, Verellen D, Baron I, van Esch G, Vanhove C, Storme G (2007) Longitudinal assessment of parotid function in patients receiving tomotherapy for head and neck cancer. Strahlenther Onkol 184:400–405

    Article  Google Scholar 

  31. Little M, Schipper M, Feng FY, Vineberg K, Cornwall C, Murdoch-Kinch CA, Eisbruch A (2012) Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys 83:1007–1014

    Article  PubMed Central  PubMed  Google Scholar 

  32. Jha N, Harris J, Seikaly H, Jacobs JR, McEwan AJ, Robbins KT, Grecula J, Sharma AK, Ang KK (2012) A phase II study of submandibular gland transfer prior to radiation for prevention of radiation-induced xerostomia in head-and-neck cancer (RTOG 0244). Int J Radiat Oncol Biol Phys 84:437–442

    Article  PubMed  Google Scholar 

  33. Wasserman TH, Brizel DM, Henke M, Monnier A, Eschwege F, Sauer R, Strnad V (2005) Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and-neck cancer: 2-year follow-up of a prospective, randomized, phase III trial. Int J Radiat Oncol Biol Phys 63:985–990

    Article  CAS  PubMed  Google Scholar 

  34. Nyarady Z, Nemeth A, Ban A, Mukics A, Nyarady J, Ember I, Olasz L (2006) A randomized study to assess the effectiveness of orally administered pilocarpine during and after radiotherapy of head and neck cancer. Anticancer Res 26:1557–1562

    CAS  PubMed  Google Scholar 

  35. Simcock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, Jenkins V, ARIX Steering Committee (2013) ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 24:776–783

    Article  CAS  PubMed  Google Scholar 

  36. Meng Z, Kay Garcia M, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Wu C, Zhao Q, Zhao G, Liu L, Spelman A, Lynn Palmer J, Wei Q, Cohen L (2012) Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer 48:1692–1699

    Article  PubMed  Google Scholar 

  37. Furness S, Bryan G, McMillan R, Birchenough S, Worthington HV (2013) Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev 8:CD009603

    PubMed  Google Scholar 

  38. Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 12:CD008934

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Hamburg–Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Silke Tribius

  2. Department of Radiation Oncology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

    Marieclaire Raguse, Christian Voigt,  Cordula Petersen Prof. Dr. med. &  Andreas Krüll

  3. Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Adrian Münscher

  4. Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Alexander Gröbe PD Dr. med. Dr. dent.

  5. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Corinna Bergelt

  6. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany

    Susanne Singer

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  1. Silke Tribius
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Correspondence to Silke Tribius.

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Conflict of interest

S. Tribius, M. Raguse, C. Voigt, A. Münscher, A. Gröbe, C. Petersen, A. Krüll, C. Bergellt and S. Singer state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies

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S. Tribius and M. Raguse contributed equally to this work.

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Tribius, S., Raguse, M., Voigt, C. et al. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Strahlenther Onkol 191, 501–510 (2015). https://doi.org/10.1007/s00066-015-0824-4

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