早期人乳头瘤病毒相关扁桃体癌单侧与双侧放射治疗中患者报告的生活质量和毒性
Patient-reported quality of life and toxicity in unilateral and bilateral radiotherapy for early-stage human papillomavirus associated tonsillar carcinoma.
作者信息
McDowell Lachlan, Casswell Georgina, Bressel Mathias, Gough Karla, Drosdowsky Allison, Coleman Andrew, Shrestha Sudi, D'Costa Ieta, Fua Tsien, Tiong Albert, Liu Chen, Ng Sweet Ping, Solomon Benjamin, Rischin Danny
机构信息
Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
出版信息
Clin Transl Radiat Oncol. 2020 Jan 30;21:85-90. doi: 10.1016/j.ctro.2020.01.004. eCollection 2020 Mar.
PURPOSE
The purpose of this study was to compare self-reported health-related quality of life (QoL) and symptom burden in early stage tonsillar carcinoma patients treated with unilateral (URT) and bilateral radiotherapy (BRT).
METHODS AND MATERIALS
This is a secondary analysis of a larger study assessing patient reported outcomes in human papillomavirus (HPV) oropharyngeal cancer (OPC) patients. Recruited patients were ≥12 months from completion of radiotherapy. This analysis included only patients with T1-2, N1-2b tonsil cancer and excluded patients with base of tongue involvement or recurrent disease. QoL and patient reported toxicity was measured using the EORTC QLQ-C30 module and the MDASI-HN.
RESULTS
Patients were enrolled from November 2018 to May 2019. Of the 136 patients recruited to the main study, 43 were eligible for this substudy (22 URT, 21 BRT), with a median age and follow up of 58.2 and 3.0 years respectively. The two groups were balanced with respect to patient, tumor and treatment factors with the exception of higher rates of T2 disease (27% v 71%, = 0.006) and more extensive GTV nodal volumes (11.0 v 25.5cc, = 0.006) in the BRT group.BRT patients had lower global health status/QoL (84 v 69, = 0.0005) and social functioning scores (93 vs 78, = 0.033) on the EORTC QLQ-C30, and higher symptom severity (0.6 vs. 2.0, = 0.001) and symptom interference scores (0.8 vs. 2.0, = 0.010) on the MDASI-HN. Four of the six largest differences observed on MDASI-HN items were attributable to radiotherapy technique (dry mouth, mucous, difficulty swallowing/chewing and taste), with corresponding dose differences to the respective organs (contralateral parotid, oral cavity and pharyngeal constrictors). In every instance, severity of symptoms was worse on average for patients treated with BRT.
CONCLUSIONS
In the highly conformal radiotherapy era, BRT in early HPV tonsillar cancer survivors has an enduring impact on long-term QoL and toxicity.
目的
本研究旨在比较接受单侧放疗（URT）和双侧放疗（BRT）的早期扁桃体癌患者自我报告的健康相关生活质量（QoL）和症状负担。
方法和材料
这是一项对一项更大规模研究的二次分析，该研究评估了人乳头瘤病毒（HPV）口咽癌（OPC）患者的患者报告结局。招募的患者自放疗结束起≥12个月。该分析仅纳入T1-2、N1-2b期扁桃体癌患者，排除舌根受累或复发性疾病患者。使用欧洲癌症研究与治疗组织QLQ-C30模块和MDASI-HN测量QoL和患者报告的毒性。
结果
患者于2018年11月至2019年5月入组。在纳入主要研究的136例患者中，43例符合本亚研究条件（22例URT，21例BRT），中位年龄和随访时间分别为58.2岁和3.0年。两组在患者、肿瘤和治疗因素方面均衡，但BRT组T2期疾病发生率较高（27%对71%，P = 0.006），GTV淋巴结体积更大（11.0对25.5cc，P = 0.006）。在欧洲癌症研究与治疗组织QLQ-C30中，BRT患者的总体健康状况/QoL得分较低（84对69，P = 0.0005），社会功能得分较低（93对78，P = 0.033），在MDASI-HN中症状严重程度得分较高（0.6对2.0，P = 0.001），症状干扰得分较高（0.8对2.0，P = 0.010）。在MDASI-HN项目中观察到的六个最大差异中有四个归因于放疗技术（口干、黏液、吞咽/咀嚼困难和味觉），与相应器官（对侧腮腺、口腔和咽缩肌）的剂量差异有关。在每种情况下，BRT治疗的患者症状严重程度平均更差。
结论
在高度适形放疗时代，早期HPV扁桃体癌幸存者接受BRT对长期QoL和毒性有持久影响。
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