Improved Quality of Life (QOL) Outcomes in Patients With Head-and-Neck Squamous Cell Carcinoma (HNSCC) Treated With Intensity Modulated Radiation Therapy (IMRT) Compared to 3-dimensional Conformal Radiation Therapy (3D-CRT): Evidence From a Prospective Randomized Study

Abstract

Purpose/Objective(s)To prospectively evaluate and compare serial longitudinal change in health-related quality of life (QOL) outcomes in patients with head-neck squamous cell carcinoma treated with intensity modulated radiation therapy (IMRT) or three-dimensional conformal radiation therapy (3D-CRT) in the context of a randomized controlled trial.Materials/MethodsBetween December 2005 and April 2008, 60 previously untreated patients randomized to either 3D-CRT (n = 28) or IMRT (n = 32) were included for analysis. QOL outcomes were assessed longitudinally by administering the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (QLQ-C30) and Head-Neck module (HN35) that had been validated and translated in local vernacular languages. QOL assessment was done prior to any treatment (at baseline) and subsequently on follow-up at 3, 6, 12, 18, and 24 months post-treatment. Mean scores of individual domains/scales at every time point were compared using the t test, while change in scores over time was evaluated by repeated measurement analysis of variance.ResultsPatient's demographic characteristics, tumor factors and baseline characteristics in QOL were comparable between the two arms. As expected, there was significant deterioration in QOL scores immediately after treatment 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 (<6 months) while physical/cognitive functioning, dry mouth, sticky saliva, fatigue, senses showed delayed recovery (>6 months). Amongst the symptom scales, dry mouth, swallowing, and mouth opening were significantly better (p < 0.05) in patients treated with IMRT compared to 3D-CRT at multiple time points. Similarly, sticky saliva, feeling ill, senses (taste/smell), pain, insomnia, social contact, and sexuality were better with IMRT though not statistically significant. QOL domains such as emotional/role functioning (p = 0.008) and social functioning (p = 0.03) were significantly improved with IMRT at 1-year and 2-years. None of the QOL domains was worse with IMRT in comparison with 3D-CRT at any time point. There were no significant differences in loco-regional or survival between the two arms.ConclusionsThe IMRT treatment in HNSCC results in better QOL scores (for most domains and symptom scales) compared to 3D-CRT with comparable disease outcomes recommending strongly its use in routine practice. Purpose/Objective(s)To prospectively evaluate and compare serial longitudinal change in health-related quality of life (QOL) outcomes in patients with head-neck squamous cell carcinoma treated with intensity modulated radiation therapy (IMRT) or three-dimensional conformal radiation therapy (3D-CRT) in the context of a randomized controlled trial. To prospectively evaluate and compare serial longitudinal change in health-related quality of life (QOL) outcomes in patients with head-neck squamous cell carcinoma treated with intensity modulated radiation therapy (IMRT) or three-dimensional conformal radiation therapy (3D-CRT) in the context of a randomized controlled trial. Materials/MethodsBetween December 2005 and April 2008, 60 previously untreated patients randomized to either 3D-CRT (n = 28) or IMRT (n = 32) were included for analysis. QOL outcomes were assessed longitudinally by administering the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (QLQ-C30) and Head-Neck module (HN35) that had been validated and translated in local vernacular languages. QOL assessment was done prior to any treatment (at baseline) and subsequently on follow-up at 3, 6, 12, 18, and 24 months post-treatment. Mean scores of individual domains/scales at every time point were compared using the t test, while change in scores over time was evaluated by repeated measurement analysis of variance. Between December 2005 and April 2008, 60 previously untreated patients randomized to either 3D-CRT (n = 28) or IMRT (n = 32) were included for analysis. QOL outcomes were assessed longitudinally by administering the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (QLQ-C30) and Head-Neck module (HN35) that had been validated and translated in local vernacular languages. QOL assessment was done prior to any treatment (at baseline) and subsequently on follow-up at 3, 6, 12, 18, and 24 months post-treatment. Mean scores of individual domains/scales at every time point were compared using the t test, while change in scores over time was evaluated by repeated measurement analysis of variance. ResultsPatient's demographic characteristics, tumor factors and baseline characteristics in QOL were comparable between the two arms. As expected, there was significant deterioration in QOL scores immediately after treatment 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 (<6 months) while physical/cognitive functioning, dry mouth, sticky saliva, fatigue, senses showed delayed recovery (>6 months). Amongst the symptom scales, dry mouth, swallowing, and mouth opening were significantly better (p < 0.05) in patients treated with IMRT compared to 3D-CRT at multiple time points. Similarly, sticky saliva, feeling ill, senses (taste/smell), pain, insomnia, social contact, and sexuality were better with IMRT though not statistically significant. QOL domains such as emotional/role functioning (p = 0.008) and social functioning (p = 0.03) were significantly improved with IMRT at 1-year and 2-years. None of the QOL domains was worse with IMRT in comparison with 3D-CRT at any time point. There were no significant differences in loco-regional or survival between the two arms. Patient's demographic characteristics, tumor factors and baseline characteristics in QOL were comparable between the two arms. As expected, there was significant deterioration in QOL scores immediately after treatment 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 (<6 months) while physical/cognitive functioning, dry mouth, sticky saliva, fatigue, senses showed delayed recovery (>6 months). Amongst the symptom scales, dry mouth, swallowing, and mouth opening were significantly better (p < 0.05) in patients treated with IMRT compared to 3D-CRT at multiple time points. Similarly, sticky saliva, feeling ill, senses (taste/smell), pain, insomnia, social contact, and sexuality were better with IMRT though not statistically significant. QOL domains such as emotional/role functioning (p = 0.008) and social functioning (p = 0.03) were significantly improved with IMRT at 1-year and 2-years. None of the QOL domains was worse with IMRT in comparison with 3D-CRT at any time point. There were no significant differences in loco-regional or survival between the two arms. ConclusionsThe IMRT treatment in HNSCC results in better QOL scores (for most domains and symptom scales) compared to 3D-CRT with comparable disease outcomes recommending strongly its use in routine practice. The IMRT treatment in HNSCC results in better QOL scores (for most domains and symptom scales) compared to 3D-CRT with comparable disease outcomes recommending strongly its use in routine practice.