Ringash Jolie, Lockwood Gina, O'Sullivan Brian, Warde Padraig, Bayley Andrew, Cummings Bernard, Kim John, Sellmann Susanna, Waldron John
Department of Radiation Oncology, The Princess Margaret Hospital, Toronto, Canada.
Radiother Oncol. 2008 May;87(2):181-7. doi: 10.1016/j.radonc.2007.12.028. Epub 2008 Jan 22.
Quality of life (QOL) was measured prospectively in a dose escalation study of twice daily hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer (HNC).
Patients with squamous cell HNC (TNM stage III/IV larynx or pharynx, or hypopharynx any stage) received 40 fractions of twice daily RT at 3 dose levels: (L1) 60Gy, 1.5Gy/fraction; (L2) 62Gy, 1.55Gy/fraction; and (L3) 64Gy, 1.6Gy/fraction. QOL was measured on the FACT-H&N at baseline, 6 and 12 months.
Mean QOL scores were: baseline 104, 6 months 108, 12 months 112. At all time points, QOL scores were lower in patients with more advanced T-category. A mixed-model analysis of determinants of QOL showed no dose effect among L1 (n=22), L2 (n=26) or L3 (n=123). QOL improved significantly with time from diagnosis, however post-treatment QOL was lower and improved more slowly in patients who had feeding tubes.
Post-RT QOL improved from baseline by a statistically and clinically significant amount. Hyperfractionated, accelerated RT provides favorable QOL outcomes, and is a viable alternative to chemoradiation for patients with locally advanced HNC.
在一项针对局部晚期头颈癌（HNC）的每日两次超分割加速放疗剂量递增研究中，对生活质量（QOL）进行了前瞻性测量。
鳞状细胞HNC患者（TNM III/IV期喉癌或咽癌，或任何分期的下咽癌）接受每日两次放疗，共40次分割，分3个剂量水平：（L1）60Gy，每次分割1.5Gy；（L2）62Gy，每次分割1.55Gy；（L3）64Gy，每次分割1.6Gy。在基线、6个月和12个月时，使用FACT-H&N量表测量生活质量。
平均生活质量得分分别为：基线时104分，6个月时108分，12个月时112分。在所有时间点，T分期越晚的患者生活质量得分越低。对生活质量决定因素的混合模型分析显示，L1组（n = 22）、L2组（n = 26）或L3组（n = 123）之间无剂量效应。生活质量随诊断时间的推移显著改善，然而，接受鼻饲管的患者治疗后的生活质量较低且改善较慢。
放疗后生活质量较基线有统计学和临床意义的显著改善。超分割加速放疗可提供良好的生活质量结果，对于局部晚期HNC患者是一种可行的放化疗替代方案。
