Kessler Peter A, Bloch-Birkholz Alexandra, Leher Anna, Neukam Friedrich Wilhelm, Wiltfang Jörg
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, D-91054 Erlangen, Germany.
Radiother Oncol. 2004 Mar;70(3):275-82. doi: 10.1016/j.radonc.2003.11.017.
In recent years, various therapeutic concepts have been developed for treating oral cancer, these include preoperative simultaneous "neoadjuvant" radio-chemotherapy and one-stage-surgery with tumour ablation and reconstruction. When considering long-term survival, there is substantial evidence that the neoadjuvant therapy is superior to the primary surgical approach with postoperative radiation. Both treatment concepts, however, have a strong impact on the quality of life.
This study prospectively evaluates and compares quality of life in 53 patients with oral cancer treated according to a neoadjuvant concept or primarily surgically, using the questionnaires QLQ C-30 and H and N35 by the EORTC.
Initially both groups showed a marked reduction in the quality of life. Despite a clear improvement in the first postoperative year baseline values were not reached in most of the scores. Specific long-lasting impairments in the symptom scales concerning oral functions were found in both treatment arms. In the neoadjuvant therapy group, however, especially global health and the emotional status were reduced to a higher degree than in the other group. This was particularly noticeable in the early treatment phase.
Following an initial deterioration of quality-of-life after 3 months a gradual improvement of physical and psychological function was observed in the course of the first post-treatment year in both groups. Severe side effects can be observed. These side effects vary strongly in their individual expression. Limitations in the quality of life can be justified, if the more aggressive therapy resulted in a better disease free survival.
近年来，已开发出多种治疗口腔癌的理念，包括术前同步“新辅助”放化疗以及肿瘤切除与重建的一期手术。在考虑长期生存时，有大量证据表明新辅助治疗优于术后放疗的原发性手术方法。然而，这两种治疗理念都对生活质量有很大影响。
本研究前瞻性评估并比较了53例根据新辅助理念或主要采用手术治疗的口腔癌患者的生活质量，使用欧洲癌症研究与治疗组织（EORTC）的QLQ C - 30问卷以及H和N35问卷。
最初两组患者的生活质量均显著下降。尽管术后第一年有明显改善，但大多数评分仍未达到基线值。在两个治疗组中均发现了与口腔功能相关症状量表中特定的长期损害。然而，在新辅助治疗组中，尤其是总体健康和情绪状态的下降程度高于另一组。这在治疗早期尤为明显。
在术后3个月生活质量最初恶化之后，两组在治疗后的第一年中均观察到身体和心理功能逐渐改善。可观察到严重的副作用。这些副作用在个体表现上差异很大。如果更积极的治疗能带来更好的无病生存期，那么生活质量的受限是合理的。
