Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2021 Oct 1;111(2):456-467. doi: 10.1016/j.ijrobp.2021.05.114. Epub 2021 May 26.
Radiation therapy is an effective but burdensome treatment for head and neck cancer (HNC). We aimed to characterize the severity and time pattern of patient-reported symptoms and quality of life in a large cohort of patients with HNC treated with definitive radiation therapy, with or without systemic treatment.
A total of 859 patients with HNC treated between 2007 and 2017 prospectively completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head and Neck Cancer module (QLQ-HN35) and Core Quality of Life Questionnaire (QLQ-C30) at regular intervals during and after treatment for up to 5 years. Patients were classified into 3 subgroups: early larynx cancer, infrahyoideal cancer, and suprahyoideal cancer. Outcome scales of both questionnaires were quantified per subgroup and time point by means of average scores and the frequency distribution of categorized severity (none, mild, moderate, and severe). Time patterns and symptom severity were characterized. Toxicity profiles were compared using linear mixed model analysis. Additional toxicity profiles based on age, human papillomavirus status, treatment modality, smoking status, tumor site, and treatment period were characterized as well.
The study population consisted of 157 patients with early larynx cancer, 304 with infrahyoideal cancer, and 398 with suprahyoideal cancer. The overall questionnaire response rate was 83%. Generally, the EORTC QLQ-HN35 symptoms reported showed a clear time pattern, with increasing scores during treatment followed by a gradual recovery in the first 2 years. Distinct toxicity profiles were seen across subgroups (P < .001), with generally less severe symptom scores in the early larynx subgroup. The EORTC QLQ-C30 functioning, quality-of-life, and general symptoms reported showed a less evident time pattern and less pronounced differences in mean scores between subgroups, although differences were still significant (P < .001). Differences in mean scores were most pronounced for role functioning, appetite loss, fatigue, and pain.
We established patient-reported toxicity and quality-of-life profiles that showed different patterns for 3 subgroups of patients with HNC. These profiles provide detailed information on the severity and persistence of various symptoms as experienced by patients during and after definitive radiation therapy. These profiles can be used to inform treatment of future patients and may serve as a benchmark for future studies.
放射治疗是一种有效的治疗方法，但对头颈部癌症（HNC）患者来说负担很重。我们旨在通过前瞻性研究，利用大样本量的接受根治性放射治疗（包括联合系统治疗）的 HNC 患者，描述其治疗期间和治疗后不同阶段的患者报告症状和生活质量的严重程度和时间模式。
2007 年至 2017 年间，共 859 例 HNC 患者接受前瞻性治疗，在治疗期间和治疗后长达 5 年的时间内，定期使用欧洲癌症研究与治疗组织（EORTC）生活质量问卷头颈部癌症模块（QLQ-HN35）和核心生活质量问卷（QLQ-C30）进行评估。患者被分为 3 个亚组：早期喉癌、下咽癌和下咽以上癌。通过平均得分和分类严重程度（无、轻度、中度和重度）的频率分布，量化两个问卷的每个亚组和时间点的量表。描述时间模式和症状严重程度。使用线性混合模型分析比较毒性概况。还描述了基于年龄、人乳头瘤病毒状态、治疗方式、吸烟状况、肿瘤部位和治疗期的其他毒性概况。
研究人群包括 157 例早期喉癌患者、304 例下咽癌患者和 398 例下咽以上癌患者。问卷调查的总体应答率为 83%。一般来说，EORTC QLQ-HN35 报告的症状具有明显的时间模式，在治疗期间评分增加，随后在前 2 年逐渐恢复。不同亚组之间存在明显的毒性谱差异（P<0.001），早期喉癌亚组的症状评分通常较轻。EORTC QLQ-C30 的功能、生活质量和一般症状报告的时间模式不明显，亚组之间的平均得分差异也不明显，但差异仍然显著（P<0.001）。角色功能、食欲减退、疲劳和疼痛的平均得分差异最为显著。
我们建立了患者报告的毒性和生活质量谱，这些谱显示了 3 组 HNC 患者的不同模式。这些谱提供了关于患者在接受根治性放射治疗期间和治疗后经历的各种症状的严重程度和持续时间的详细信息。这些谱可用于指导未来患者的治疗，并可作为未来研究的基准。
