Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Asklepios Hospital St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
Strahlenther Onkol. 2021 Mar;197(3):219-230. doi: 10.1007/s00066-020-01737-2. Epub 2020 Dec 30.
Intensity-modulated radiation therapy (IMRT) enables radiation oncologists to optimally spare organs at risk while achieving homogeneous dose distribution in the target volume. Despite great advances in technology, xerostomia is one of the most detrimental long-term side effects after multimodal therapy in patients with locally advanced head and neck cancer (HNC). This prospective observational study examines the effect of parotid sparing on quality of life in long-term survivors.
A total of 138 patients were grouped into unilateral (n = 75) and bilateral (n = 63) parotid sparing IMRT and questioned at 3, 24, and 60-month follow-up using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-H&N35 questionnaires. Treatment-related toxicity was scored according to the RTOG/EORTC toxicity criteria. Patients' QoL 24 and 60 months after IMRT was analyzed by ANCOVA using baseline QoL (3 months after IMRT) as a covariate.
Patients with bilateral and unilateral parotid-sparing IMRT surviving 60 months experience similar acute and late side effects and similar changes in QoL. Three months after IMRT, physical and emotional function as well as fatigue, nausea and vomiting, pain, dyspnea, and financial problems are below (function scales) or above (symptom scales) the threshold of clinical importance. In both groups, symptom burden (EORTC H&N35) is high independent of parotid sparing 3 months after IMRT and decreases over time in a similar pattern. Pain and financial function remain burdensome throughout.
Long-term HNC survivors show a similar treatment-related toxicity profile independent of unilateral vs. bilateral parotid-sparing IMRT. Sparing one or both parotids had no effect on global QoL nor on the magnitude of changes in function and symptom scales over the observation period of 60 months. The financial impact of the disease and its detrimental effect on long-term QoL pose an additional risk to unmet needs in this special patient population. These results suggest that long-term survivors need and most likely will benefit from early medical intervention and support within survivorship programs.
调强放疗（IMRT）使放射肿瘤学家能够在目标体积中实现均匀剂量分布的同时，最大限度地保护危险器官。尽管技术有了很大的进步，但口干症是局部晚期头颈部癌症（HNC）患者多模态治疗后最具危害性的长期副作用之一。这项前瞻性观察研究探讨了在长期生存者中保护腮腺对生活质量的影响。
共有 138 名患者被分为单侧（n=75）和双侧（n=63）腮腺保护调强放疗组，并在 3、24 和 60 个月随访时使用欧洲癌症研究与治疗组织 EORTC QLQ-C30 和 QLQ-H&N35 问卷进行询问。根据 RTOG/EORTC 毒性标准对治疗相关毒性进行评分。使用 IMRT 后 3 个月的基线 QoL 作为协变量，通过 ANCOVA 分析 IMRT 后 24 和 60 个月患者的 QoL。
60 个月后存活的双侧和单侧腮腺保护调强放疗患者经历类似的急性和迟发性副作用，生活质量变化也相似。IMRT 后 3 个月时，身体和情绪功能以及疲劳、恶心和呕吐、疼痛、呼吸困难和经济问题低于（功能量表）或高于（症状量表）临床重要性的阈值。在两组中，腮腺保护 3 个月后，EORTC H&N35 症状负担均较高，且随着时间的推移呈相似模式下降。疼痛和财务功能始终是负担。
长期 HNC 幸存者表现出相似的治疗相关毒性特征，与单侧与双侧腮腺保护调强放疗无关。单侧或双侧腮腺保护对整体 QoL 或功能和症状量表在 60 个月观察期内的变化幅度均无影响。疾病的经济影响及其对长期 QoL 的不利影响给这一特殊患者群体带来了额外的未满足需求。这些结果表明，长期幸存者需要并可能受益于生存计划中的早期医疗干预和支持。
