Parotid sparing and quality of life in long-term survivors of locally advanced head and neck cancer after intensity-modulated radiation therapy
Tóm tắt
Intensity-modulated radiation therapy (IMRT) enables radiation oncologists to optimally spare organs at risk while achieving homogeneous dose distribution in the target volume. Despite great advances in technology, xerostomia is one of the most detrimental long-term side effects after multimodal therapy in patients with locally advanced head and neck cancer (HNC). This prospective observational study examines the effect of parotid sparing on quality of life in long-term survivors. A total of 138 patients were grouped into unilateral (n = 75) and bilateral (n = 63) parotid sparing IMRT and questioned at 3, 24, and 60-month follow-up using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-H&N35 questionnaires. Treatment-related toxicity was scored according to the RTOG/EORTC toxicity criteria. Patients’ QoL 24 and 60 months after IMRT was analyzed by ANCOVA using baseline QoL (3 months after IMRT) as a covariate. Patients with bilateral and unilateral parotid-sparing IMRT surviving 60 months experience similar acute and late side effects and similar changes in QoL. Three months after IMRT, physical and emotional function as well as fatigue, nausea and vomiting, pain, dyspnea, and financial problems are below (function scales) or above (symptom scales) the threshold of clinical importance. In both groups, symptom burden (EORTC H&N35) is high independent of parotid sparing 3 months after IMRT and decreases over time in a similar pattern. Pain and financial function remain burdensome throughout. Long-term HNC survivors show a similar treatment-related toxicity profile independent of unilateral vs. bilateral parotid-sparing IMRT. Sparing one or both parotids had no effect on global QoL nor on the magnitude of changes in function and symptom scales over the observation period of 60 months. The financial impact of the disease and its detrimental effect on long-term QoL pose an additional risk to unmet needs in this special patient population. These results suggest that long-term survivors need and most likely will benefit from early medical intervention and support within survivorship programs.
Từ khóa
Tài liệu tham khảo
https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 5 September 2020
Jabbari S et al (2005) Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: initial report. Int J Radiat Oncol Biol Phys 63(3):725–731
Jellema AP et al (2007) Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys 69(3):751–760
Abel E et al (2017) Impact on quality of life of IMRT versus 3‑D conformal radiation therapy in head and neck cancer patients: a case control study. Adv Radiat Oncol 2(3):346–353
Nutting CM et al (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12(2):127–136
Jensen SB et al (2019) Salivary gland hypofunction and xerostomia in head and neck radiation patients. J Natl Cancer Inst Monogr 2019(53):lgz016. https://doi.org/10.1093/jncimonographs/lgz016
Tribius S et al (2015) Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Strahlenther Onkol 191(6):501–510
Mogadas S et al (2020) Influence of radiation dose to pharyngeal constrictor muscles on late dysphagia and quality of life in patients with locally advanced oropharyngeal carcinoma. Strahlenther Onkol 196(6):522–529
Little M et al (2012) Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys 83(3):1007–1014
Tribius S et al (2013) Xerostomia after radiotherapy. What matters—Mean total dose or dose to each parotid gland? Strahlenther Onkol 189(3):216–222
Roesink JM et al (2005) A comparison of mean parotid gland dose with measures of parotid gland function after radiotherapy for head-and-neck cancer: implications for future trials. Int J Radiat Oncol Biol Phys 63(4):1006–1009
Eisbruch A et al (1999) Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 45(3):577–587
Deasy JO et al (2010) Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 76(3 Suppl):S58–S63
Price RE et al (1995) Effects of continuous hyperfractionated accelerated and conventionally fractionated radiotherapy on the parotid and submandibular salivary glands of rhesus monkeys. Radiother Oncol 34(1):39–46
Lombaert IM et al (2008) Rescue of salivary gland function after stem cell transplantation in irradiated glands. PLoS ONE 3(4):e2063
Hawkins PG et al (2018) Sparing all salivary glands with IMRT for head and neck cancer: longitudinal study of patient-reported xerostomia and head-and-neck quality of life. Radiother Oncol 126(1):68–74
Jellema AP et al (2007) Unilateral versus bilateral irradiation in squamous cell head and neck cancer in relation to patient-rated xerostomia and sticky saliva. Radiother Oncol 85(1):83–89
Sommat K et al (2019) Clinical and dosimetric predictors of physician and patient reported xerostomia following intensity modulated radiotherapy for nasopharyngeal cancer—A prospective cohort analysis. Radiother Oncol 138:149–157
Teng F et al (2019) Reducing xerostomia by comprehensive protection of salivary glands in intensity-modulated radiation therapy with helical tomotherapy technique for head-and-neck cancer patients: a prospective observational study. Biomed Res Int 2019:2401743
Bernier J, Vermorken JB, Koch WM (2006) Adjuvant therapy in patients with resected poor-risk head and neck cancer. J Clin Oncol 24(17):2629–2635
Cooper JS et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944
Cooper JS et al (2012) Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 84(5):1198–1205
Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31(5):1341–1346
N.A. (1995) LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Biol Phys 31(5):1049–1091
Rubin P et al (1995) EORTC Late Effects Working Group. Overview of late effects normal tissues (LENT) scoring system. Radiother Oncol 35(1):9–10
Rubin P et al (1995) RTOG Late Effects Working Group. Overview. Late Effects of Normal Tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 31(5):1041–1042
Aaronson NK et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376
Bjordal K et al (1994) Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group. Acta Oncol 33(8):879–885
Fayers PM, Aaronson N, Bjordal K, EORTC Quality of Life Study Group, - (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels
King MT (1996) The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 5(6):555–567
Giesinger JM et al (2020) Thresholds for clinical importance were defined for the European organisation for research and treatment of cancer computer adaptive testing core-an adaptive measure of core quality of life domains in oncology clinical practice and research. J Clin Epidemiol 117:117–125
Arraras JI et al (2002) The EORTC QLQ-C30 (version 3.0) quality of life questionnaire: validation study for Spain with head and neck cancer patients. Psychooncology 11(3):249–256
Singer S et al (2013) Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review. Qual Life Res 22(8):1927–1941
Singer S et al (2009) Validation of the EORTC QLQ-C30 and EORTC QLQ-H&N35 in patients with laryngeal cancer after surgery. Head Neck 31(1):64–76
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Academic Press, New York
Osoba D et al (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144
King AJ et al (2015) Prostate cancer and supportive care: a systematic review and qualitative synthesis of men’s experiences and unmet needs. Eur J Cancer Care (Engl) 24(5):618–634
Paterson C et al (2017) Unmet supportive care needs of men with locally advanced and metastatic prostate cancer on hormonal treatment: a mixed methods study. Cancer Nurs 40(6):497–507
Moore HCF (2020) Breast cancer survivorship. Semin Oncol 47(4):222–228
Koh J et al (2019) Head and neck squamous cell carcinoma survivorship care. Aust J Gen Pract 48(12):846–848
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21492. Accessed 31 August 2020
Bjordal K, Mastekaasa A, Kaasa S (1995) Self-reported satisfaction with life and physical health in long-term cancer survivors and a matched control group. Eur J Cancer B Oral Oncol 31B(5):340–345
Pow EH et al (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66(4):981–991
Vergeer MR et al (2009) Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: results of a nonrandomized prospective study using a standardized follow-up program. Int J Radiat Oncol Biol Phys 74(1):1–8
Ringash J et al (2005) Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia. Int J Radiat Oncol Biol Phys 61(5):1403–1407
Hunter KU et al (2013) Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 85(4):935–940
Richards TM et al (2017) The effect of parotid gland-sparing intensity-modulated radiotherapy on salivary composition, flow rate and xerostomia measures. Oral Dis 23(7):990–1000
Elting LS et al (2008) Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer 113(10):2704–2713
Tribius S et al (2012) Global quality of life during the acute toxicity phase of multimodality treatment for patients with head and neck cancer: can we identify patients most at risk of profound quality of life decline? Oral Oncol 48(9):898–904
Jellema AP et al (2005) Does radiation dose to the salivary glands and oral cavity predict patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with curative radiotherapy? Radiother Oncol 77(2):164–171
Meirovitz A et al (2006) Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys 66(2):445–453
Meyer F et al (2012) Predictors of severe acute and late toxicities in patients with localized head-and-neck cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys 82(4):1454–1462
El-Deiry MW et al (2009) Influences and predictors of long-term quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg 135(4):380–384
Funk GF, Karnell LH, Christensen AJ (2012) Long-term health-related quality of life in survivors of head and neck cancer. Arch Otolaryngol Head Neck Surg 138(2):123–133
Scrimger R et al (2007) Correlation between saliva production and quality of life measurements in head and neck cancer patients treated with intensity-modulated radiotherapy. Am J Clin Oncol 30(3):271–277
Beetz I et al (2014) The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia. Acta Oncol 53(5):597–604
Robbins KT (1992) Head and neck oncology. Otolaryngol Head Neck Surg 106(1):7–8
Veldeman L et al (2008) Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 9(4):367–375
Massa ST et al (2019) Comparison of the financial burden of survivors of head and neck cancer with other cancer survivors. JAMA Otolaryngol Head Neck Surg 145(3):239–249
Tribius S et al (2018) Socioeconomic status and quality of life in patients with locally advanced head and neck cancer. Strahlenther Onkol 194(8):737–749
Buettner M et al (2019) Out-of-pocket-payments and the financial burden of 502 cancer patients of working age in Germany: results from a longitudinal study. Support Care Cancer 27(6):2221–2228
Koch R et al (2015) Employment pathways and work-related issues in head and neck cancer survivors. Head Neck 37(4):585–593
Giesinger JM, Loth FLC, Aaronson NK et al (2020) Thresholds for clinical importance were defined for the European organisation for research and treatment of cancer computer adaptive testing core-an adaptive measure of core quality of life domains in oncology clinical practice and research. J Clin Epidemiol 117:117–125
