Late toxicity and quality of life in oral cavity and oropharyngeal cancer survivors treated with chemoradiotherapy.

Abstract

9092 Background: Concurrent chemoradiotherapy (CRT) in unresectable head and neck cancer (HNC) leads to a better loco-regional control and an overall survival benefit over RT alone, but an increased toxicity is also seen. Late effects are often persistent and may affect the long term health related quality of life (HRQL) of HNC survivors. Objectives: (a) Identify the prevalence of clinical late toxicities (cLT) grade≥2 in oral cavity (OrC) and oropharyngeal (OrP) cancer survivors after CRT. (b) Assess HRQL in this population. (c) Explore potential associations between (a) and (b). Methods: Patients (pts) who were disease-free at least 1 year after CRT were eligible for this cross-sectional study. cLT was assessed by physical exam and graded according to NCI-CTCAE v.3; nutritional status was assessed by body mass index; and HRQL by the EORTC QLQ-C30 and QLQ-H&N35 cancer module questionnaires. The results were compared with the EORTC QLQ-C30 Reference Values (RV) for the general population. Results: 40 pts included, median age 59 (33-71); 38 male (95%), 2 female (5%). Most of them had stage IV disease (73%) and OrP cancer (70%). Median follow-up 2.4 years. Malnutrition was found in 12 pts (30%), being severe in 4 (10%). cLT grade≥2 were found in 27 pts (67.5%). The most common were dry mouth (50%), dental problems (45%), sticky saliva (25%), dysphagia (17.5%) and neck fibrosis (12.5%). The mean global QLQ-C30 score was 61.7 (standard deviation 18.7), which is lower than the RV (75.3). This was due to the globally lower QLQ-C30 symptom scale scores. The worse QLQ-H&N35 scale scores were dry mouth (71.7), sticky saliva (68.3), teeth problems (40.0), diminished libido (32.1) and trismus (28.3). In this limited number sample, it was not possible to demonstrate a difference in terms of global HRQL score between the pts with or without cLT grade≥2 (Wilcoxon rank sum test, p=0.19). Conclusions: More than half of the CRT-treated OrC and OrP cancer pts have significant cLT. The symptoms reported by the pts in QLQ-H&N35 are similar to the observed cLT. This HNC survivors population has a globally low HRQL score. Less toxic regimens are needed in order to increase the quality of the years these pts gain from more aggressive treatments. No significant financial relationships to disclose.