Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer

Tribius, Silke; Raguse, M.; Voigt, Christian; Münscher, Adrian; Gröbe, Alexander; Petersen, Cordula; Krüll, Andreas; Bergelt, Corinna; Schnittger, Susanne

doi:10.1007/s00066-015-0824-4

Cited by 46 publications

(43 citation statements)

References 36 publications

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“…Although nadirs in subjective functioning generally were reached at 4 weeks after therapy, a gradual return to baseline in all domains was observed as expected. These were largely consistent with data published regarding patients treated with full‐dose radiation regimens with the caveat that recovery clearly occurred earlier . Surprisingly, mood and anxiety stabilized to levels above baseline even by time points within the acute toxicity phase, suggesting that the psychological consequences of treatment were not as profound as those typically observed among patients treated with conventional regimens.…”

Section: Discussionsupporting

confidence: 88%

“…This threshold may be challenging to avoid in some clinical scenarios when macroscopic disease rests immediately adjacent to these structures and the maximum radiation dose level is 70 Gy. In addition, multiple studies have noted that even with modern treatment techniques, QOL recovery often takes >1 year . As such, lower maximum dose levels may improve the morbidity profile of treatment.…”

Section: Introductionmentioning

confidence: 99%

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Patient‐reported quality‐of‐life outcomes after de‐escalated chemoradiation for human papillomavirus‐positive oropharyngeal carcinoma: Findings from a phase 2 trial

Hegde

Shaverdian

Daly

et al. 2017

Cancer

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Purpose This study represents a subset analysis of quality of life outcomes among patients treated on a phase II trial of de-escalated chemoradiation for human papillomavirus (HPV)-associated oropharynx cancer. Methods Eligibility included newly-diagnosed, stage III or IV oropharyngeal squamous cell carcinoma, p16-positivity, age at least 18 years, and Zubrod performance status 0–1. Treatment was induction paclitaxel 175 mg/m2 and carboplatin AUC 6 for 2 cycles followed by response-adapted, dose-reduced radiation of 54 Gy or 60 Gy with weekly concurrent paclitaxel 30 mg/m2. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaires were used to assess patient-reported quality of life as a secondary endpoint. Results Forty-five patients were registered, of whom 40 completed quality of life surveys and were evaluable. Nadirs for overall UW-QOL and FACT-H&N scores were reached at 4 weeks after treatment but returned to baseline at 3 months. Nearly all functional indices returned to baseline levels by 6 to 9 months. The mean overall UW-QOL score was 71.6 at baseline compared to 70.8, 73.0, 83.3, and 81.1, at 3-months, 6-months, 1-year, and 2-years, respectively, post-therapy. The proportion rating their overall quality of life as “very good” or “outstanding” at 6-months, 1-year, and 2-years with the UW-QOL was 50%, 77%, and 84%, respectively. Conclusion This de-escalation regimen achieved quality of life outcomes that were favorable compared to historical controls. These results serve as powerful evidence that ongoing de-escalation efforts lead to tangible gains in function and quality of life.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Patient‐reported quality‐of‐life outcomes after de‐escalated chemoradiation for human papillomavirus‐positive oropharyngeal carcinoma: Findings from a phase 2 trial

Hegde

Shaverdian

Daly

et al. 2017

Cancer

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“…The largest differences were found for symptoms related to the tumor location, such as problems with local pain, sticky saliva, or opening of the mouth, all of which have an impact on the ability to eat, swallow, and obtain required nutrition. It seems reasonable to conclude that the quality at life of patients with head and neck cancer is already affected at diagnosis because the HRQOL scores from the study used for comparison with the reference values were comparable to results from other HRQOL studies …”

Section: Discussionmentioning

confidence: 54%

Population-based reference values for the European Organization for Research and Treatment of Cancer Head and Neck module

Adnan

Silander

2017

Head & Neck

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“…33,44 Concerning xerostomia and neck fibrosis, our patients did not use medication nor did they receive an intervention. 45 Up to 5 years after treatment, some evidence regarding late toxicity and the impact on QOL is available, with some studies showing a worsening in dry mouth and sticky saliva from baseline to 5 years of followup. All patients were counseled during and after treatment by a multidisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy

et al. 2019

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Background Acute and late toxicity after intensity‐modulated radiotherapy (IMRT) for head and neck cancer (HNC) impacts on patient quality of life; yet, very late toxicity data remain scarce. This study assessed dysphagia, xerostomia, and neck fibrosis 3‐8 years after IMRT. Methods A retrospective analysis using generalized estimated equations was performed on 60 patients with HNC treated with fractionated IMRT between 2000 and 2015 who had a follow‐up ≥8 years. Toxicity was scored using LENT‐SOMA scales. Results A trend towards a nonlinear global time effect (P = .05) was noted for dysphagia with a decrease during the 5 years post‐treatment and an increase thereafter. A significant decrease in xerostomia (P = .001) and an increase in neck fibrosis (P = .04) was observed until 8 years. Conclusions Dysphagia, xerostomia, and neck fibrosis do not appear stable over time and remain highly prevalent in the very late follow‐up. Our findings support the need for prospective trials investigating very late toxicity in patients with HNC.

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Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer

Cited by 46 publications

References 36 publications

Patient‐reported quality‐of‐life outcomes after de‐escalated chemoradiation for human papillomavirus‐positive oropharyngeal carcinoma: Findings from a phase 2 trial

Patient‐reported quality‐of‐life outcomes after de‐escalated chemoradiation for human papillomavirus‐positive oropharyngeal carcinoma: Findings from a phase 2 trial

Population-based reference values for the European Organization for Research and Treatment of Cancer Head and Neck module

Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy

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