Abstract
Objectives: Long-term quality-of-life data following stereotactic body radiation therapy (SBRT) for recurrent head and neck cancer (rHNC) is underreported. We report patient-reported quality-of-life (PR-QOL) after at least 1 year post-treatment.Methods and Materials: A retrospective review was performed on 64 patients receiving SBRT for previously-irradiated rHNC. PR-QOL was prospectively evaluated using the University of Washington Quality of Life Questionnaire. The mixed effects proportional odds model was used to assess post-treatment overall PR-QOL changes, as well as the effects of late toxicities, tumor volume > 25 cc, local failure, nodal recurrence, distant failure, prior neck dissection, performance status other than ECOG 0 or Karnofsky 100, sex, age >65, squamous vs. non-squamous primary histology, and specific organ recurrence.Results: SBRT had no significant effect on overall PR-QOL at days 1-90 post-treatment (SBRT effect 0.035, p = 0.93) and days 91–365 (SBRT effect −0.30, p = 0.45). Beyond day 365, overall PR-QOL was significantly worse than baseline (SBRT effect −0.77, p =.03). Grade ≥3 late toxicities (p = 0.0072) and tumor volume > 25 cc (p = 0.032) predicted significantly worse overall PR-QOL. Oral cavity recurrence predicted significant decrements in chewing (p = 0.0006), swallowing (p = 0.0301), and taste PR-QOL (p = 0.02). Nasal recurrence predicted significant decrements in taste PR-QOL (p = 0.030). Grade ≥3 late dysphagia predicted significant decline in chewing (p = 0.039) and swallowing (p = 0.0004). Grade ≥3 late osteonecrosis predicted significant differences in pain PR-QOL (p = 0.0026).Conclusion: PR-QOL across several domains declines immediately after SBRT for previously-irradiated rHNC before returning to baseline levels at 1 year. Long-term PR-QOL declines thereafter. Patients with grade ≥3 late toxicities or tumor volume >25 cc report reduced long-term overall PR-QOL, likely representing late disease progression. Specific organ recurrence and grade ≥3 late toxicities predict decrements in specific PR-QOL domains.
Highlights
Locoregional failure remains a major challenge in the management of head and neck cancer, as it affects 20–50% of patients [1] and represents the most common cause of mortality [2]
From November 2004 to January 2016, 391 patients with previously-irradiated, locally-recurrent or second primary head and neck cancer were treated with Stereotactic body radiation therapy (SBRT)
Beyond day 365, overall patient-reported quality-of-life (PR-QOL) was significantly worse than baseline (SBRT effect −0.77, p =.03)
Summary
Locoregional failure remains a major challenge in the management of head and neck cancer, as it affects 20–50% of patients [1] and represents the most common cause of mortality [2]. Surgical salvage offers the best outcomes for patients with recurrent disease, providing a median overall survival (OS) of 44 months, compared to 11 months in patients with unresectable disease [3]. The remaining therapeutic options for patients with recurrent head and neck cancer (rHNC)—radiation therapy and/or systemic chemotherapy—have traditionally been suboptimal. Stereotactic body radiation therapy (SBRT) has recently emerged as a promising salvage treatment for rHNC, as it provides similar clinical outcomes to intensity-modulated radiation therapy (IMRT) in a shorter treatment window of 1–2 weeks, compared to 6–7 weeks for IMRT, while potentially reducing toxicities [5]. Vargo et al previously analyzed PR-QOL after SBRT ± cetuximab for rHNC with a median follow-up of 6 months. Vargo et al previously analyzed PR-QOL after SBRT ± cetuximab for rHNC with a median follow-up of 6 months. [7] They reported that overall PR-QOL, health-related PRQOL, and specific domains—swallowing, speech, saliva, activity, and recreation—show gradual improvement after an initial decrement at 1-month post-treatment
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