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Radiotherapy-related quality of life in patients with head and neck cancers: a meta-analysis

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Abstract

Objectives

To compare effects of intensity-modulated radiotherapy (IMRT) with those of conventional radiotherapy on quality of life (QoL) and severity of xerostomia in patients with head and neck cancer.

Material and methods

PubMed, Cochrane, and Embase databases were searched to July 1, 2019, to identify relevant studies, using the following terms: radiotherapy, head and neck cancer, quality of life, cognition, xerostomia, two-/three-dimensional conformal radiation therapy, IMRT, conformal proton beam radiation therapy, stereotactic radiosurgery, and volumetric modulated arc therapy. The outcomes of interest were QoL measured by global health status; emotional, social, and cognitive function; and severity of xerostomia.

Results

Seven studies with a total of 761 patients (n = 369 with IMRT; n = 392 with conventional RT) were included in this study. Median patient age was 18–65 years. IMRT group patients had better global health status (pooled standardized mean difference [SMD] = 0.80, 95% CI 0.26 to 1.35, P = 0.004) and cognitive function (pooled SMD = 0.30, 95% CI 0.06 to 0.54, P = 0.013) than the conventional RT group. Patients receiving IMRT also had significantly lower scores for xerostomia than those receiving conventional RT (pooled SMD = − 0.60, 95% CI − 0.97 to − 0.24, P = 0.001). No differences were found in emotional function (P = 0.531) and social function (P = 0.348) between the two groups.

Conclusion

IMRT significantly improves QoL and reduces the severity of xerostomia in patients with head and neck cancer. Results of this study provide clinicians with guidelines for decisions on the use of IMRT versus conventional RT.

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Abbreviations

CCB:

Concomitant boost technique

EORTC:

European Organization for Research and Treatment of Cancer

EORTC H&H35:

European Organization for Research and Treatment of Cancer head and neck cancer questionnaire

EORTC QLQ-C30:

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire

EORTC QLQ H&N35:

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Module for Head and Neck Cancer

FACT:

Functional Assessment of Cancer Treatment questionnaire

FACT H&H:

Functional Assessment of Cancer Treatment head and neck questionnaire

GTV:

Gross tumor volume

HR:

Hazard ratio

HNQOL:

Head and Neck Quality of Life instrument

IMRT:

Intensity-modulated radiotherapy

OARs:

Organs at risk

OR:

Odds ratio

PGTVnx:

Primary gross tumor volume of nasopharynx

PGTVnd:

Primary gross tumor volume of neck dissection

PCTV:

Primary control tumor volume

PCTVnd:

Primary control tumor volume of neck dissection

PTV:

Planning target volume

QoL:

Quality of life

RT:

Radiation therapy

SF-36:

Medical Outcomes Study Short-Form (36-item) Health Survey

UWQOL:

University of Washington Quality of Life Questionnaire

VMAT:

Volumetric modulated arc therapy

XQ:

Xerostomia questionnaire

2D-RT:

Two-dimensional radiation therapy

3D-CRT:

Three-dimensional conformal radiation therapy

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Funding

This research was supported by the National Natural Science Foundation of China (nos. 81771158, 81871337), Zhejiang Provincial Natural Science Foundation of China (nos. LY16H180007, LY13H180016),and the Science Foundation from Health Commission of Zhejiang Province (nos. 2013RCA001, 201522257, 2016KYA014).

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Authors and Affiliations

  1. Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Rd, Hangzhou, 310006, China

    Xiuhong Ge & Zhongxiang Ding

  2. Department of Psychiatry, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, 158 Shangtang Rd, Hangzhou, 310014, China

    Zhengluan Liao & Enyan Yu

  3. Department of Radiology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, 158 Shangtang Rd, Hangzhou, 310014, China

    Jianhua Yuan, Dewang Mao & Yumei Li

  4. College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China

    Xunheng Wang

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  1. Xiuhong Ge
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Correspondence to Enyan Yu or Zhongxiang Ding.

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Ge, X., Liao, Z., Yuan, J. et al. Radiotherapy-related quality of life in patients with head and neck cancers: a meta-analysis. Support Care Cancer 28, 2701–2712 (2020). https://doi.org/10.1007/s00520-019-05077-5

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