Department of Radiation Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Hospital, Tata Memorial Centre, Kharghar, Navi Mumbai, Mumbai, India.
Oral Oncol. 2013 Jun;49(6):634-42. doi: 10.1016/j.oraloncology.2013.02.013. Epub 2013 Apr 4.
PURPOSE: To prospectively evaluate and compare health-related quality-of-life (QOL) outcomes in patients with head-neck squamous cell carcinoma randomized to either intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) and assess serial longitudinal change in QOL over time. METHODS: QOL outcomes were assessed using the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (QLQ-C30) and Head-Neck module (HN-35) at baseline (pre-treatment) and subsequently periodically on follow-up. Mean scores of individual domains/scales of 3D-CRT and IMRT were compared using 't' test at each time point; while longitudinal change in mean scores of both groups over time was evaluated by repeated measurement analysis of variance. RESULTS: Fifty eight of the 60 randomized patients who filled the QOL questionnaire at least at one time point were included in the analysis. Several general (emotional functioning, role functioning, social contact) as well as head and neck cancer-specific (dry mouth, opening mouth, sticky saliva, pain, senses) QOL domains were better preserved with IMRT compared to 3D-CRT at different time points. Importantly, none of the QOL domains were worse with IMRT at any time point. There was substantial deterioration in QOL scores immediate post-treatment (3-months) in both arms. However, QOL scores gradually but definitely improved over time for most domains. Global QOL, emotional/role functioning, nausea/vomiting, pain, swallowing, speech, social contact/eating, insomnia showed rapid recovery (<6months) while physical/cognitive functioning, dry mouth, sticky saliva, fatigue, senses showed delayed recovery (>6months). There were no significant differences in loco-regional or survival between the two arms. CONCLUSIONS: There is substantial deterioration in QOL after curative-intent head-neck irradiation that gradually improves over time. IMRT results in clinically meaningful and statistically better QOL scores for some domains compared to 3D-CRT at several time points with comparable disease outcomes that could support its widespread adoption in routine clinical practice.
目的：前瞻性评估和比较头颈部鳞状细胞癌患者的健康相关生活质量（QOL）结果，这些患者随机分为调强放疗（IMRT）或三维适形放疗（3D-CRT），并评估随时间推移 QOL 的纵向变化。 方法：使用欧洲癌症研究与治疗组织（EORTC）生活质量问卷（QLQ-C30）和头颈部模块（HN-35）在基线（治疗前）和随后的随访期间定期评估 QOL 结果。在每个时间点使用“t”检验比较 3D-CRT 和 IMRT 的各个领域/量表的平均得分；同时，通过重复测量方差分析评估两组随时间的平均得分的纵向变化。 结果：在至少一个时间点填写 QOL 问卷的 60 名随机患者中有 58 名被纳入分析。与 3D-CRT 相比，IMRT 在不同时间点更好地保留了几个一般（情绪功能、角色功能、社会接触）以及头颈部癌症特异性（口干、张口、粘唾液、疼痛、感觉）的 QOL 领域。重要的是，在任何时间点，IMRT 都没有使 QOL 领域恶化。在两个治疗臂中，治疗后（3 个月）QOL 评分都明显恶化。然而，随着时间的推移，大多数领域的 QOL 评分逐渐但肯定得到改善。总体 QOL、情绪/角色功能、恶心/呕吐、疼痛、吞咽、言语、社会接触/进食、失眠在 6 个月内迅速恢复，而身体/认知功能、口干、粘唾液、疲劳、感觉则恢复较慢（6 个月以上）。两个治疗臂之间在局部区域或生存方面没有显著差异。 结论：头颈部根治性照射后 QOL 明显恶化，随时间逐渐改善。与 3D-CRT 相比，IMRT 在几个时间点上为某些领域提供了更有意义和统计学上更好的 QOL 评分，同时具有可比的疾病结果，这可能支持其在常规临床实践中的广泛应用。
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