High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Abstract

a b s t r a c tBackground and purpose: Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer leads to a high incidence of severe, mostly esophageal, toxicity. The purpose of this study was to investigate the evolution of quality of life (QoL) in patients with lung cancer, selected for curative radiotherapy (RT) or chemo-RT. Methods: Seventy-five lung cancer patients completed a longitudinal the EORTC QLQ-C30 and LC13. Linear mixed regression models were fitted to investigate the impact of different factors on overall QoL. Results: Overall QoL decreased shortly after the end of RT (4 points, p = 0.19), but increased back to baseline within 3 months. Mean scores of role functioning (p = 0.018), cognitive functioning (p = 0.002), dyspnoea (EORTC QLQ-LC13; p = 0.043), dysphagia (p = 0.005) and hoarseness (p = 0.029), showed a significant worsening over time. Emotional functioning (p = 0.033) improved significantly over time. Severe esophagitis (Pgrade 2) was reported in only 12% of the patients. Next to maximal esophageal toxicity Pgrade 2 (p = .0.010), also tumor stage IIIA (p < 0.001), tumor stage IIIB (p = 0.003), gender (p = 0.042) and fatigue (p < 0.001) appeared to be significant predictors of QoL. Conclusion: High-dose radiotherapy or concurrent chemo-radiation in the treatment of lung cancer seems to be a well-tolerated treatment option with preservation of QoL. Lung cancer remains a major public health problem worldwide because of its high incidence, rapid progression, and poor outcome [1]. The majority of patients who develop lung cancer die of this disease within a year [2]. Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer is standard care for patients with locally advanced disease, i.e. stage III non-small cell lung cancer (NSCLC) or limited stage small cell lung carcinoma (LD-SCLC) [3,4].Combined concurrent modality treatment increases long-term survival, but at the expense of a higher incidence of severe esophagitis [5][6][7][8]. In order to allow proper balancing between expected benefits and drawbacks of aggressive therapy, knowledge of the effects of a given treatment on the quality of life (QoL) is needed.An optimal therapy could be defined as one that increases survival or provides benefit through reduction in cancer-related symptoms and improved QoL.To the best of our knowledge, in only one study, QoL assessment was performed in patients receiving high-dose radiotherapy for NSCLC [9]. No data are at present known on the influence of concurrent chemo-radiation on the QoL.Moreover, a broad Medline search using the terms ''QoL and SCLC" (December 2008) revealed only 15 studies of which none examined QoL after radiotherapy treatment.The purpose of this study was to investigate the evolution of QoL on NSCLC stages I-III and LD-SCLC patients, referred for hyperfractionated accelerated high-dose radiotherapy (RT) with or without concurrent chemotherapy, with curative intent. Since we hypothesized that QoL would be considerably influenced by esophageal...

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