Quality of life outcomes after primary radiotherapy for squamous cell carcinoma of the base of tongue.

PURPOSE

To determine quality of life functional outcome after primary radiotherapy for carcinoma of the base of tongue.

METHODS AND MATERIALS

At the University of Florida, essentially all patients with squamous cell carcinoma of the base of tongue are treated with primary continuous-course, external-beam radiotherapy alone or followed by a neck dissection. Fifty-three patients who remained continuously free of disease at 2 to 23 years were eligible to participate in an assessment of the posttreatment quality of their lives. Three patients could not be located for quality of life assessment, and one patient refused to participate, leaving 49 evaluable patients. Radiotherapy doses were 60 to 75 Gy in once daily fractions, or 74 to 79 Gy in twice daily fractions. The subjective Performance Status Scale for Head and Neck Cancer, which assigns a functional score ranging from 0 to 100, was completed by each of the patients during routine follow-up appointments. The scale measures ability to eat in public, understandability of speech, and normalcy of diet.

RESULTS

Patients treated with external-beam radiotherapy alone had excellent results with regard to eating in public though scores showed a decline as T stage increased (average scores were T1: 90.6%; T2: 88.1%; T3: 82.8%; T4: 75.0%). Results for understandability of speech were T1: 93.75%; T2: 100%; T3: 82.8%; and T4: 87.5%. Fixation of the tongue at diagnosis was not a predictor of poor function. Normalcy of diet scores likewise decreased with increasing T stage: T1: 93.8%; T2: 89.5%; T3: 71.3%; T4: 60.0%. The addition of a neck dissection had no impact on the functional outcomes that were evaluated. Functional results did not deteriorate with prolonged follow-up of more than 5 years. Results were compared with those from the literature for patients treated by surgery plus postoperative radiotherapy or external-beam irradiation plus interstitial 192Ir implant. The functional results of high-dose external-beam irradiation alone in the present series were similar to those reported after external plus interstitial irradiation. The functional results after both types of radiation treatment were superior to results for patients who underwent surgery.

CONCLUSIONS

Functional outcomes after external-beam radiotherapy were similar to those after external-beam plus 192Ir implant, and were superior to the results of surgical resection. Planned postradiotherapy neck dissection did not affect the analyzed functional endpoints. Function appeared to be stable by 5 years without subsequent change.