Radiotherapy-related quality of life in patients with head and neck cancers: a meta-analysis

Sinha

Laskar

et al. 2020

Preprint

Purpose: To compare long-term disease-related outcomes and late radiation morbidity between intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in head and neck squamous cell carcinoma (HNSCC) in the setting of a prospective randomized controlled trial.Methods: Previously untreated patients with early to moderately advanced non-metastatic squamous carcinoma of the oropharynx, larynx, or hypopharynx (T1-T3, N0-N2b, M0) planned for comprehensive irradiation of primary site and bilateral neck nodes were randomly assigned to either IMRT or 3D-CRT after written informed consent. Patients were treated with 6MV photons to a total dose of 70Gy/35 fractions over 7 weeks (3D-CRT) or 66Gy/30 fractions over 6 weeks (IMRT). A sample size of 60 patients was estimated to demonstrate 35% absolute difference in the incidence of ≥grade 2 acute xerostomia between the two arms. All time-to-event outcomes were calculated from date of randomization until the defined event using the Kaplan-Meier method. Results: At a median follow-up of 140 months for surviving patients, 10-year Kaplan-Meier estimates of loco-regional control (LRC); progression-free survival (PFS); and overall survival (OS) with 95% confidence interval (95%CI) were 73.6% (95%CI: 61.2-86%); 45.2% (95%CI: 32-58.4%); and 50.3% (95%CI: 37.1-63.5%) respectively. There were no significant differences in 10-year disease-related outcomes between 3D-CRT and IMRT for LRC [79.2% (95%CI: 62.2-96.2%) vs 68.7% (95%CI: 51.1-86.3%), p=0.39]; PFS [41.3% (95%CI: 22.3-60.3%) vs 48.6% (95%CI: 30.6-66.6%), p=0.59]; or OS [44.9% (95%CI: 25.7-64.1%) vs 55.0% (95%CI: 37-73%), p=0.49]. Significantly lesser proportion of patients in the IMRT arm experienced ≥grade 2 late xerostomia and subcutaneous fibrosis at all time-points. However, at longer follow-up, fewer patients remained evaluable for late radiation toxicity reducing statistical power and precision. Conclusions: IMRT provides a clinically meaningful and sustained reduction in the incidence of moderate to severe xerostomia and subcutaneous fibrosis compared to 3D-CRT without compromising disease-related outcomes in long-term survivors of non-nasopharyngeal HNSCC.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial

Sinha

Laskar

et al. 2020

Preprint

“…5). [18][19][20] Petsuksiri et al found patients who received IMRT to have lower incidence of SNHL when compared with conventional RT (37 vs. 48.75% at 4 kHz). 21 A study done by Theunissen et al included 101 patients who received IMRT for various head and neck tumors and their hearing loss was compared with the normal hearing for that respective age.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hearing Loss in Patients Receiving Chemoradiotherapy in Adjuvant Setting for Head and Neck Malignancy

Annals of Otology and Neurotology

Bhat

Rao

et al. 2020

Introduction The aim of the study is to assess the hearing loss in patients who receive chemoradiation (chemoradiotherapy or CTRT) for head and neck malignancies. Materials and Methods Prospective study was conducted in the Department of ENT of a tertiary care center from September 2013 to August 2014. Forty patients suffering from head and neck malignancies (histologically proven) were included in the study. Patients with pre-existing hearing loss were excluded. All patients received radiotherapy dose of 66 to 70 Gy given as 2 Gy/d, 5 d/wk and chemotherapy dose of cisplatin 35 mg/m2 once a week for 6 weeks. Hearing was assessed by pure tone audiometry (PTA) and impedance audiometry conducted at regular intervals. Mcnemars chi-square test was used to compare the impedance and paired t-test and Pearson’s correlation were used to compare PTA at various stages. Results Predominantly male patients (28) falling in the age group of 40 to 60 years, suffered from various head and neck cancer, most common being oropharynx (14). Twenty patients developed sensorineural hearing loss (SNHL)—11(55%) had mild, seven (35%) had moderate, and two (10%) had severe grade of SNHL. Majority of these patients, 12 (60%) started developing SNHL mid-therapy, five (25%) at the completion of therapy and three (15%) 3 months post-therapy. Hearing loss was found to be more with two-dimensional radiotherapy (2DRT) and three-dimensional radiotherapy (3DRT) than with intensity-modulated radiotherapy (IMRT) as assessed by serial PTA. The average dose of radiation to right and left ears, respectively were 27.10 and 24.66 Gy. The incidence of otitis media with effusion increased during the treatment accounting for the conductive hearing loss irrespective of the modality of radiation used. Conclusion CTRT causes significant hearing loss in patients suffering from head and neck malignancies leading to further increase in the morbidity. Screening audiological assessment would be helpful to know the pretherapy status of the ear. Using newer modalities like IMRT can reduce hearing loss. Regular audiological screening can catch it at its onset and help in early use of hearing aids.

“…Traditionally, HNSCC had been treated with conventional RT techniques which generally comprised of simple eld arrangements, typically parallel-opposed portals with or without matching low anterior neck eld or antero-lateral wedge pair based on two-dimensional (2D) uoroscopic imaging with no major emphasis on shielding of normal tissues. Such conventional techniques led to considerable morbidity (3) such as dryness of mouth, sticky saliva, swallowing dysfunction, and subcutaneous brosis with resultant negative impact upon health-related quality-of-life (QOL) in longterm survivors (4,5). Over the years, technological advances in treatment planning and delivery based on computed tomographic (CT) imaging have resulted in progressive conformation of radiation dose to the target tissues while sparing adjacent organs-at-risk (OARs) ushering in the era of three-dimensional conformal RT (3D-CRT).…”

Section: Introductionmentioning

confidence: 99%

Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial

Sinha

Laskar

et al. 2020

Preprint

Background: To compare long-term disease-related outcomes and late radiation morbidity between intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in head and neck squamous cell carcinoma (HNSCC) in the setting of a prospective randomized controlled trial.Methods: Previously untreated patients with early to moderately advanced non-metastatic squamous carcinoma of the oropharynx, larynx, or hypopharynx (T1-T3, N0-N2b, M0) were randomly assigned to either IMRT or 3D-CRT after written informed consent. Patients were treated with 6MV photons to a total dose of 70Gy/35 fractions over 7 weeks (3D-CRT) or 66Gy/30 fractions over 6 weeks (IMRT). A sample size of 60 patients was estimated to demonstrate 35% absolute difference in the incidence of ≥grade 2 acute xerostomia between the two arms. All time-to-event outcomes were calculated from date of randomization till the defined event using the product-limit method of Kaplan-Meier. Results: At a median follow-up of 140 months for surviving patients, 10-year Kaplan-Meier estimates of loco-regional failure free-survival (LRFFS); final loco-regional control (LRC) including surgical salvage; and overall survival (OS) with 95% confidence interval (95%CI) were 72% (95%CI: 59.4-84.6%); 79.7% (95%CI: 68.7-90.7%); and 50.3% (95%CI: 37.1-63.5%) respectively. There were no significant differences in 10-year disease-related outcomes between 3D-CRT and IMRT for LRRFS [75.7% (95%CI: 58.1-93.3%) vs 68.7% (95%CI: 51.1-86.3%), p=0.56]; final LRC [83% (95%CI: 67.2-98.8%) vs 76.9% (95%CI: 61.5-92.3%), p=0.50]; or OS [44.9% (95%CI: 25.7-64.1%) vs 55.0% (95%CI: 37-73%), p=0.49]. Significantly lesser proportion of patients in the IMRT arm experienced ≥grade 2 late xerostomia and subcutaneous fibrosis at all time-points. However, at longer follow-up, lesser number of patients remained evaluable for late radiation toxicity reducing statistical power and precision. Conclusions: IMRT provides a clinically meaningful and sustained reduction in the incidence of moderate to severe xerostomia and subcutaneous fibrosis compared to 3D-CRT without compromising disease-related outcomes in long-term survivors of non-nasopharyngeal HNSCC. Trial registration: Registered at the Clinical Trials Registry of India (CTRI/2008/091/000045) (Retrospectively registered)