Quality of life in patients treated for head and neck cancer: A follow-up study 7 to 11 years after radiotherapy

Bjordal, Kristin; Kaasa, Stein; Mastekaasa, Arne

doi:10.1016/0360-3016(94)90104-x

Cited by 283 publications

(162 citation statements)

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“…In many surveys that monitored the results of RT in patients with head and neck cancer, xerostomia usually was cited as the most prevalent late complication. [28][29][30][31][32] It has been reported that patient-reported xerostomia is correlated significantly with the mean RT dose to the parotid glands and the minor salivary glands in the oral cavity. 33 Our study further confirmed that RT technique is the unique variable affecting xerostomia in NPC survivors.…”

Section: Discussionmentioning

confidence: 99%

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Fang

Tsai

Chen

et al. 2007

Cancer

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BACKGROUND.It was reported previously that the dosimetric superiority of conformal radiotherapy (RT), either 3‐dimensional conformal RT (3D‐CRT) or intensity‐modulated RT (IMRT), over conventional 2D‐RT translated into clinical benefits for patients with nasopharyngeal carcinoma (NPC). In this study, the authors compared quality‐of‐life (QOL) outcomes of NPC survivors who received treatment with 1 of 4 different RT techniques at a single institute during different periods.METHODS.The authors analyzed QOL data of from 237 patients with NPC who were cancer free for 2 or 3 years when their QOL was assessed. The study population included 152 patients who received conventional RT (2D‐RT, 61 patients; 2D‐RT plus 3D‐CRT boost, 91 patients) and 85 patients who received conformal RT (3D‐CRT, 33 patients; IMRT, 52 patients). The European Organization for the Research and Treatment of Cancer (EORTC) Core QOL questionnaire and the EORTC Head and Neck QOL questionnaire were completed.RESULTS.Compared with patients who received with conventional RT, patients who received conformal RT had both statistically (P < .05) and clinically (a difference in mean scores ≥10 points) significant improvements in the scales of global QOL, pain, appetite loss, senses, speech, social eating, teeth, opening mouth, xerostomia, sticky saliva, and feeling ill. No significant difference was observed in any of the scales that compared 2D‐RT with 2D‐RT plus 3D‐CRT boost or that compared 3D‐CRT with IMRT. Survivors who received conformal RT had a 2.01‐fold higher probability (odds ratio [OR], 2.01; 95% confidence interval [95% CI], 1.19–3.68) of reporting good global QOL and a 2.70‐fold lower probability (OR, 0.37; 95% CI, 0.20–0.66) of reporting a high level of xerostomia than survivors who received conventional RT.CONCLUSIONS.Conformal RT substantially improved head and neck‐related symptoms and broad aspects of QOL for survivors of NPC. Cancer 2007. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Fang

Tsai

Chen

et al. 2007

Cancer

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“…Radiation from conventional beam arrangement impairs the function of salivary glands and frequently results in permanent xerostomia [13]. The decreased secretion of saliva is responsible for altered taste sensation, impaired mastication and deglutition, compromised oral hygiene, and reduced quality of life [14,15]. Parotid glands account for approximately one-half to two-thirds of the total salivary output [16].…”

Section: Discussionmentioning

confidence: 99%

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Cheng

Chao

Low

2001

Intl Journal of Cancer

125

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SUMMARY We studied target volume coverage and normal tissue sparing of serial tomotherapy intensity modulated radiation therapy (IMRT) and fixed-field IMRT for nasopharyngeal carcinoma (NPC), as compared with those of conventional beam arrangements. Twelve patients with NPC (T2-4N1-3M0) at Mallinckrodt Institute of Radiology underwent computed tomography simulation. Images were then transferred to a virtual simulation workstation computer for target contouring. Target gross tumor volumes (GTV) were primary nasopharyngeal tumor (GTV NP ) with a prescription of 70 Gy, grossly enlarged cervical nodes (GTV LN ) with a prescription of 70 Gy, and the uninvolved cervical lymphatics [designated as the clinical tumor volume (CTV)] with a prescription of 60 Gy. Critical organs, including the parotid gland, spinal cord, brain stem, mandible, and pituitary gland, were also delineated. Conventional beam arrangements were designed following the guidelines of Intergroup (SWOG, RTOG, ECOG) NPC Study 0099 in which the dose was prescribed to the central axis and the target volumes were aimed to receive the prescribed dose ± 10%. Similar dosimetric criteria were used to assess the target volume coverage capability of IMRT. Serial tomotherapy IMRT was planned using a 0.86-cm wide multivane collimator, while a dynamic multileaf collimator system with five equally spaced fixed gantry angles was designated for fixed-beam IMRT. The fractional volume of each critical organ that received a certain predefined threshold dose was obtained from dose-volume histograms of each organ in either the three-dimensional or IMRT treatment planning computer systems. Statistical analysis (paired t-test) was used to examine statistical significance. We found that serial tomotherapy achieved similar target volume coverage as conventional techniques (97.8 ± 2.3% vs. 98.9 ± 1.3%). The static-field IMRT technique (five equally spaced fields) was inferior, with 92.1 ± 8.6% fractional GTV NP receiving 70 Gy ± 10% dose (P < 0.05). However, GTV LN coverage of 70 Gy was significantly better with both IMRT techniques (96.1 ± 3.2%, 87.7 ± 10.6%, and 42.2 ± 21% for tomotherapy, fixed-field IMRT, and conventional therapy, respectively). CTV coverage of 60 Gy was also significantly better with the IMRT techniques. Parotid gland sparing was quantified by evaluating the fractional volume of parotid gland receiving more than 30 Gy; 66.6 ± 15%, 48.3 ± 4%, and 93 ± 10% of the parotid volume received more than 30 Gy using tomotherapy, fixed-field IMRT, and conventional therapy, respectively (P < 0.05). Fixed-field IMRT technique had the best parotid-sparing effect despite less desirable target coverage. The pituitary gland, mandible, spinal cord, and brain stem were also better spared by both IMRT techniques. These encouraging dosimetric results substantiate the theoretical advantage of inverse-planning IMRT in the management of Publication of the International Union Against Cancer NPC. We showed that target coverage of the primary tumor was maintained and nodal coverage ...

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“…However, as rates of long-term remission and cure following therapy for certain malignancies improve, achieving this with a minimum of late side-effects is becoming more important. There is a great deal of evidence to suggest that various aspects of quality of life are reduced in survivors of cancer (Fobair et al, 1986;Berglund et al, 1991;Bjordal et al, 1994;Hjermstad and Kaasa, 1995;Greenberg et al, 1997). Therefore, assessment of quality of life after therapy is a vital part of determining the overall efficacy of different treatment regimens.…”

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confidence: 99%

Fatigue, sexual function and mood following treatment for haematological malignancy: the impact of mild Leydig cell dysfunction

et al. 2000

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Summary Fatigue, sexual dysfunction, anxiety and depression are all more common in patients who have previously been treated with cytotoxic chemotherapy and radiotherapy (XRT) for haematological malignancies. Following therapy, a significant proportion of men have biochemical evidence of Leydig cell dysfunction, defined by a raised luteinizing hormone level in the presence of a low/normal testosterone level. We postulated that mild testosterone deficiency may account for some of the long-term side-effects of treatment, and we have therefore assessed fatigue, mood and sexual function by questionnaire in 36 patients with Leydig cell dysfunction (group 1), and also in a group of 30 patients (group 2) with normal hormone levels who underwent the same treatment for cancer. There was no significant difference in anxiety and depression scores between the two groups although anxiety scores were higher than those previously reported for normal men. Eightyseven per cent of group 2 were sexually active compared with only 69% of group 1 (P = 0.1), and patients in group 1 engaged less in sexual activity than those in group 2 (mean of 1.8 times per week compared with 3.2 times per week; P = 0.02) Fatigue scores were significantly higher in both groups compared with normal men, but there were no significant differences in any of the fatigue subscales between the two groups. We conclude that mild Leydig cell insufficiency following treatment with cytotoxic chemotherapy ± XRT is not associated with higher levels of fatigue and anxiety but may result in reduced sexual function. These results do not provide a convincing argument that androgen replacement therapy is mandatory to improve quality of life in the majority of these patients, although it may be beneficial in a minority. To establish criteria for selection of patients for a trial of androgen therapy a randomized placebo-controlled study will be necessary.

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Quality of life in patients treated for head and neck cancer: A follow-up study 7 to 11 years after radiotherapy

Cited by 283 publications

References 14 publications

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Fatigue, sexual function and mood following treatment for haematological malignancy: the impact of mild Leydig cell dysfunction

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