Abstract
Background and purposeTo assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients.Patients and nethodsQuestionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192). Overall response was 85% (n = 163); 97% in the IMRT group (n = 75) and 77% in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis.ResultsPatients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the "spared" parotid below 26 Gy.ConclusionParotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT.
Highlights
In radiotherapy for head and neck cancer, the major salivary glands frequently receive a high radiation dose
Parotid gland sparing intensity modulated radiotherapy (IMRT) for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals
In the surgery-IMRT group one of the submandibular glands was removed in 53% of the cases, both submandibular glands in 12%, 6% had their superficial parotid gland removed another 6% had their superficial parotid gland and one submandibular gland removed, 18% kept all their major salivary glands, in 5% of the patients it was unknown
Summary
In radiotherapy for head and neck cancer, the major salivary glands frequently receive a high radiation dose. A high dose on the salivary glands results in a reduction of salivary output and a change in its composition [1,2]. This in turn may lead to xerostomia which is cited by patients as a major cause of decreased quality of life (QoL) [1,2]. To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis
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