Long-term Quality of Life for Surgical and Nonsurgical Treatment of Head and Neck Cancer

Abstract

To compare the long-term, health-related quality-of-life outcomes in patients with advanced head and neck cancer (HNC) treated with surgery and postoperative radiation therapy (SRT) or concurrent chemotherapy and radiation therapy (CRT).Design: Matched-pair study comparing patients with advanced HNC treated with SRT or CRT at least 12 months after treatment. Patients completed 2 validated surveys addressing HNC-specific outcomes and depressive symptoms and provided information on employment and tobacco and alcohol use. Results for the 2 groups were compared using paired-sample t test and 2 analysis.Setting: University-based study. Patients: Patients with stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, and larynx who underwent SRT or received CRT. Main Outcome Measures: Head and neck cancer-specific health-related quality of life from the Head and Neck Cancer Inventory and level of depressive symptoms from the Beck Depression Inventory.Results: The matching process resulted in 27 patients in each treatment group. The HNC-specific domain scores (with higher scores representing better outcomes) for CRT vs SRT were eating, 37.8 vs 40.8 (P=.69); speech, 65.1 vs 56.0 (P=.23); aesthetics, 80.3 vs 69.2 (P=.14); and social disruption, 69.7 vs 70.6 (P = .90). Overall healthrelated quality of life was 64.0 with SRT and 55.0 with CRT (P=.142). For the Beck Depression Inventory (with higher scores representing worse outcomes), patients who underwent SRT had a mean score of 9.6 compared with 11.6 for patients who received CRT (P =.42). Conclusion:As nonsurgical means of treating HNC have become more aggressive and surgical techniques have become more focused on function preservation and rehabilitation, the overall health-related quality of life resulting from these different approaches is similar.

Chemoradiation for patients with advanced oral cavity cancer

“…[2][3][4][5][6][7][8][9] This may be due to perceptions that radiation, particularly for T4 bony lesions, is an ineffective modality for advanced OCC. In addition, it is generally thought that radiation doses that would be considered therapeutic for advanced OCC would lead to unacceptable toxicities in the form of xerostomia, or radiation-induced soft-tissue or bone necrosis.…”

Long-term Health-Related Quality of Life in Survivors of Head and Neck Cancer

“…There has been an emergence of chemotherapy and epidermal growth factor receptor inhibitor use as well as an abandonment of more radical, function-disrupting surgery for function-sparing approaches accompanied by considerable improvement in the ability to reconstruct and rehabilitate surgical defects. 8,[63][64][65][66] Also, comparing across studies is complicated by the different methods used to evaluate and define HRQOL. 67 Despite these difficulties, the population of patients with HNC needs to be included in the expanding evaluation of cancer survivorship issues for a number of rea- sons.…”

Current Reconstructive Techniques Following Head and Neck Cancer Resection Using Microvascular Surgery

“…With recent advances in concurrent chemoradiotherapy (CCRT), organ conservation is an important aim in HNSCC therapy, 1) similar to disease control; however, CCRT is limited to the control rate of advanced local cancer, and post-therapeutic dysfunction is still an issue. 2,3) More than 50% of advanced HNSCCs require reconstruction of surgical defects to prevent functional and cosmetic issues (our original data). Furthermore, as there are many important structures in the head and neck region, complications after surgery sometimes result in postoperative death by rupture of the carotid artery and meningitis after skull base surgery.…”