Transcript ASTRO_2007- Second Malignancy after SGC

Intensity-Modulated Radiotherapy is Associated with Improved Global
Quality of Life Among Long-Term Survivors of Head and Neck Cancer
Allen M. Chen, M.D., D. Gregory Farwell, M.D., Quang Luu, M.D., Esther G. Vazquez, R.N., Derick H. Lau, M.D.,Ph.D., and James A. Purdy, Ph.D.
Departments of Radiation Oncology, Otolaryngology- Head and Neck Surgery, and Medical Oncology,
University of California, Davis, School of Medicine, Sacramento, CA
Purpose/Objectives
Results
Although intensity-modulated radiotherapy (IMRT) has become
widely adopted in the management of head and neck cancer,
limited clinical data exists on its potential impact on long-term
quality of life. This issue is particularly relevant as an increasing
number of head and neck cancer patients are surviving for longer
periods of time after treatment. Moreover, since radiation therapy
has traditionally been associated with profoundly detrimental
effects on oral and physical health, the influence of more recently
applied advanced technologies such as IMRT on quality of life is
of considerable interest. The purpose of this study was to
compare long-term quality of life among patients treated by IMRT
and non-IMRT (3DCRT) techniques for head and neck cancer.
The mean global quality of life scores were 67.5 and 80.1 for the IMRT patients
at 1- and 2-years, respectively, compared to 55.4 and 57.0 for the 3DCRT
patients, respectively (p<0.001). At 1-year after completion of radiation therapy,
the proportion of patients who rated their global quality of life as “very good” or
“outstanding” was 51% and 41% among patients treated by IMRT and 3DCRT,
respectively (p=0.11). At 2-years, the corresponding percentages increased to
73% and 49%, respectively (p<0.001). On multivariate analysis accounting for
gender, age, radiation intent (definitive versus postoperative), radiation dose, Tstage, primary site, use of concurrent chemotherapy, and neck dissection, the
use of IMRT was the only variable independently associated with improved
quality of life (p=0.01).
Material and Methods
The University of Washington Quality of Life instrument (UWQOL) is a validated, self-administered questionnaire that patients
returning for follow-up after completion of radiation therapy for
head and neck cancer have routinely completed at our institution
since 2007. The UW-QOL scores were retrospectively reviewed
for 155 patients with squamous cell carcinomas of the head and
neck requiring bilateral neck irradiation for locally advanced
disease. Only patients who were clinically without evidence of
recurrent disease and with at least 2 years of follow-up were
included in this analysis. Patients who had undergone total
laryngectomy at any time were specifically excluded.
Figure 1: Mean global quality of life scores after completion of radiation therapy according to technique.
Conclusion
The early quality of life improvements associated with IMRT are not only
maintained but apparently become more magnified over time. Although
quality of life is a somewhat subjective concept without a single, universally
accepted definition, these data powerful evidence attesting to the long-term
benefits of IMRT for head and neck cancer.