Quality of life of nasopharyngeal carcinoma patients

Talmi, Yoav P.; Horowitz, Zeev; Bedrin, Lev; Wolf, Michael; Chaushu, Gavriel; Kronenberg, Jona; Pfeffer, M. Raphael

doi:10.1002/cncr.10342

Cited by 61 publications

(46 citation statements)

References 16 publications

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“…Some groups recommend bilateral neck and TMI in this setting, claiming improved local control [58,59]. With conventional RT technique, this is at the price of significant acute toxicity and chronic morbidity (mainly xerostomia with its associated complications [6,60,61] and effects on QOL [13,62]). …”

Section: Squamous Cell Carcinoma With Unknown Primarymentioning

confidence: 99%

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

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Newbold²,

Harrington³

et al. 2012

BJR

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ABSTRACT. Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional two-dimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-modulated radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This article reviews the current role of IMRT in head and neck cancer from the point of view of normal tissue sparing, and also reviews the current published literature by individual head and neck cancer subsites. In addition, we briefly discuss the role of image guidance in head and neck IMRT, and future directions in this area. Intensity-modulated radiotherapy (IMRT) is an advanced approach to three-dimensional (3D) treatment planning and conformal therapy. It optimises the delivery of irradiation to irregularly shaped volumes and has the ability to produce concavities in radiation treatment volumes. For head and neck cancer, the clinical target volume 1 (CTV1), which includes the primary tumour and the involved nodes, typically receives a higher radiation dose than CTV2. The different doses to CTV1 and 2 can be delivered simultaneously, while sparing the parotid salivary glands and the spinal cord. In the head and neck region, IMRT has a number of potential advantages: (i) it allows for greater sparing of normal structures such as salivary glands, oesophagus, optic nerves, brain stem and spinal cord [7,8]; (ii) it allows treatment to be delivered in a single treatment phase without the requirement for matching additional fields to provide tumour boosts, and eliminates the need for electron fields to the posterior (levels II and V) neck nodes; and (iii) it offers the possibility of simultaneously delivering higher radiation doses to regions of gross disease and lower doses to areas of microscopic disease-the so-called simultaneous integrated boost (SIB) IMRT [9].IMRT can be delivered using linear accelerators with static multileaf collimators (MLCs; step and shoot IMRT) or dynamic leaf MLCs, tomotherapy machines or volumetric modulated arc therapy (VMAT). Tomotherapy enables the simultaneous use of image guidance and treatment delivery [10]. However, adaptive RT based on image guidance is yet to be clinically optimised in head and neck cancer. VMAT is a newer technique of delivering IMRT. VMAT delivers IMRT-like distributions in a single rotation of the gantry, varying the gantry speed and dose rate during delivery, in contrast to standard IMRT, which uses fixed gantry beams. Planning studies using RT demonstrate shorter planning and treatment time, fewer monitor units for treatment delivery and better dose homogeneity and normal tissue sparing [11,12]. There is a lack of data as regards clinical implementation of this technique.IMRT was first described in 1999; in the last decade numerous retrospective case series (single and multiinstitution) and a few randomised trials have been published studying the clinical implementation of thi...

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Section: Squamous Cell Carcinoma With Unknown Primarymentioning

confidence: 99%

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Bhide

Newbold²,

Harrington³

et al. 2012

BJR

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“…The EORTC QLQ-H&N35 is widely used to measure quality of life in H&N cancer patients (Singer et al, 2013). Both prospective and cross-sectional studies (Bjordal et al, 2001;Hammerlid et al, 2001aHammerlid et al, , 2001bHammerlid et al, , 2001cNguyen et al, 2002;Talmi et al, 2002;Shepherd and Fisher, 2004) have documented reductions in HRQOL in populations of H&N cancer patients who have received RT. Several studies have also examined changes in HRQOL during the treatment period (Bjordal et al, 2001;Henson et al, 2001; Airolldi et al, 2004;Parliament et al, 2004;Jabbari et al, 2005; Braam et al, 2007; Curran et al, 2007; Ackerstaff et al, 2009; Ackerstaff et al, 2012;Maguire et al, 2011;Maurer et al, 2011;Nutting et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Changes in health related quality of life in women and men undergoing radiation treatment for head and neck cancer and the impact of smoking status in the radiation treatment period

Egestad

Emaus

2014

European Journal of Oncology Nursing

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Abstract:Purpose The aim of this study was to evaluate health-related quality of life (HRQOL) in women and men undergoing radiation treatment for head and neck cancer through the intervention period and examine if age, body mass index (BMI) and smoking status at baseline may modify changes in HRQOL. Results Most aspects of HRQOL declined substantially and significantly (p<0.001) with a magnitude of more than one standard deviation during the radiation treatment period irrespective of sex and age. Smoking status at baseline had some, albeit minor, influence on changes in HRQOL. Patients who continued smoking during therapy had significantly higher decline in several aspects of HRQOL, compared to patients who stopped smoking.Conclusions HRQOL decline with substantial magnitude in patients undergoing radiation treatment for head and neck cancer, but smoking cessation may modify the declining quality of life. IntroductionTreatments of head and neck (H&N) cancer include surgery, radiotherapy (RT), chemotherapy, target therapy or a combination of these modalities. The diagnosis and the following treatment may exert a severe impact on patient's quality of life (QOL) (So et al., 2012). The malignancy affects the most visible area of the body, and may influence the most fundamental activities of daily life in a negative way, such as speech, breathing, eating and drinking (Larsson and Hedelin, 2003;Wells 1998). H&N cancer patients' illness often involves physical symptoms, psychological distress, as well as side effects from RT (Archer et al., 2008). The treatment can result in dry mouth (xerostomia), oral discomfort, mucositis, recurrent microbial infections, difficulty in chewing and swallowing, increased incidence of dental caries, impaired taste, and an inability to wear dentures (Parsons et al., 1994). In addition, depression is reported to increase in H&N cancer patients undergoing RT (Neilson et al., 2010;Kelly et al., 2007).The interest in health-related quality of life (HRQOL) (i.e. the physical, mental, and social functioning and well-being) in H&N cancer patients has increased over the two decades (So et al., 2012). Even if the most important outcome for cancer patients is overall survival, the disease and its treatment often have a major impact on HRQOL and functional status (List et al., 2002). Reliable and valid HRQOL questionnaires are available (Aaronson et al., 1993; Bjordal et al., 2000;Ringash and Bezjak, 2001). The EORTC QLQ-H&N35 is widely used to measure quality of life in H&N cancer patients (Singer et al., 2013). Both prospective and cross-sectional studies (Bjordal et al., 2001;Hammerlid et al., 2001aHammerlid et al., , 2001bHammerlid et al., , 2001cNguyen et al., 2002;Talmi et al., 2002;Shepherd and Fisher, 2004) have documented reductions in HRQOL in populations of H&N cancer patients who have received RT. Several studies have also examined changes in HRQOL during the treatment period (Bjordal et al., 2001;Henson et al., 2001; Airolldi et al., 2004;Parliament et al., 2004;Jabbari et al., 2...

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“…The damage to the gland was long lasting and had significant effects on the patients' quality of life. Xerostomia is one of the commonest radiation-induced complications in nasopharyngeal carcinoma (NPC) patients after a radical course of radiotherapy [1,2]. Persistent xerostomia, which is due to the damage of the parotid glands, causes difficulties in mastication and swallowing and enhances the risks of dental problems; these subsequently degrade the quality of life in long-term survivors [3,4].…”

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confidence: 99%

Evaluation of radiation-induced changes to parotid glands following conventional radiotherapy in patients with nasopharygneal carcinoma

Wu¹,

Ying²,

Kwong³

2011

BJR

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Objectives: Xerostomia is a common post-radiotherapy (post-RT) complication in nasopharyngeal carcinoma (NPC) patients. This study evaluated the relation of post-RT parotid gland changes with the dose received. Methods: Data from 18 NPC patients treated by radiotherapy between 1997 and 2001 were collected. Parotid gland volumes were measured and compared between their pre-RT and post-RT CT images; both sets of CT were conducted with the same scanning protocol. Doppler ultrasound was used to assess the haemodynamic condition of the glands after radiotherapy. Doppler ultrasound results were compared against 18 agematched normal participants. A questionnaire was used to evaluate the patients' comments of xerostomia condition. Radiotherapy treatment plans of the participants were retrieved from the Eclipse treatment planning system from which the radiation doses delivered to the parotid glands were estimated. The correlations of parotid gland doses and the post-RT changes were evaluated. Results: The post-RT parotid glands were significantly smaller (p,0.001) than the pre-RT ones. They also demonstrated lower vascular velocity, resistive and pulsatility indices (p,0.05) than normal participants. The degree of volume shrinkage and subjective severity of xerostomia demonstrated dose dependence, but such dependence was not definite in the haemodynamic changes. Conclusion: It was possible to predict the gland volume change and subjective severity of xerostomia based on the dose to the parotid glands for NPC patients. However, such prediction was not effective for the vascular changes. The damage to the gland was long lasting and had significant effects on the patients' quality of life. Xerostomia is one of the commonest radiation-induced complications in nasopharyngeal carcinoma (NPC) patients after a radical course of radiotherapy [1,2]. Persistent xerostomia, which is due to the damage of the parotid glands, causes difficulties in mastication and swallowing and enhances the risks of dental problems; these subsequently degrade the quality of life in long-term survivors [3,4].With the recent advancements in radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), highly conformal dose distributions are possible and the sparing of parotid gland can be made more effective. However, conventional radiotherapy protocol for NPC is still used in some centres, and the treatment protocol is to employ lateral opposing beams to the face and upper neck plus an anterior beam to cover the lower neck. This inevitably irradiates the parotid glands to a mean dose of over 45 Gy, with the medial portion receiving as high as 60 Gy [5,6].Up to now, the mechanism of parotid gland damage and saliva reduction due to radiation is largely unknown. It is postulated that the saliva secretion of the parotid glands is related to the changes in morphology and vascular condition as a result of radiation therapy [7]. CT is a useful imaging tool for monitoring the response of radiation therapy by providing morphological information of th...

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Quality of life of nasopharyngeal carcinoma patients

Cited by 61 publications

References 16 publications

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Changes in health related quality of life in women and men undergoing radiation treatment for head and neck cancer and the impact of smoking status in the radiation treatment period

Evaluation of radiation-induced changes to parotid glands following conventional radiotherapy in patients with nasopharygneal carcinoma

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