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The mean global quality of life scores were 67.5 and 80.1 for the IMRT patients at 1- and 2-years, respectively, compared to 55.4 and 57.0 for the 3DCRT patients, respectively (p<0.001). At 1-year after completion of radiation therapy, the proportion of patients who rated their global quality of life as “very good” or “outstanding” was 51% and 41% among patients treated by IMRT and 3DCRT, respectively (p=0.11). At 2-years, the corresponding percentages increased to 73% and 49%, respectively (p<0.001). On multivariate analysis accounting for gender, age, radiation intent (definitive versus postoperative), radiation dose, T-stage, primary site, use of concurrent chemotherapy, and neck dissection, the use of IMRT was the only variable independently associated with improved quality of life (p=0.01).
The early quality of life improvements associated with IMRT are not only maintained but apparently become more magnified over time. Although quality of life is a somewhat subjective concept without a single, universally accepted definition, these data powerful evidence attesting to the long-term benefits of IMRT for head and neck cancer.
Although intensity-modulated radiotherapy (IMRT) has become widely adopted in the management of head and neck cancer, limited clinical data exists on its potential impact on long-term quality of life. This issue is particularly relevant as an increasing number of head and neck cancer patients are surviving for longer periods of time after treatment. Moreover, since radiation therapy has traditionally been associated with profoundly detrimental effects on oral and physical health, the influence of more recently applied advanced technologies such as IMRT on quality of life is of considerable interest. The purpose of this study was to compare long-term quality of life among patients treated by IMRT and non-IMRT (3DCRT) techniques for head and neck cancer.
Material and Methods
The University of Washington Quality of Life instrument (UW-QOL) is a validated, self-administered questionnaire that patients returning for follow-up after completion of radiation therapy for head and neck cancer have routinely completed at our institution since 2007. The UW-QOL scores were retrospectively reviewed for 155 patients with squamous cell carcinomas of the head and neck requiring bilateral neck irradiation for locally advanced disease. Only patients who were clinically without evidence of recurrent disease and with at least 2 years of follow-up were included in this analysis. Patients who had undergone total laryngectomy at any time were specifically excluded.
Intensity-Modulated Radiotherapy is Associated with Improved Global Quality of Life Among Long-Term Survivors of Head and Neck Cancer
Allen M. Chen, M.D., D. Gregory Farwell, M.D., Quang Luu, M.D., Esther G. Vazquez, R.N., Derick H. Lau, M.D.,Ph.D., and James A. Purdy, Ph.D.
Departments of Radiation Oncology, Otolaryngology- Head and Neck Surgery, and Medical Oncology,
University of California, Davis, School of Medicine, Sacramento, CA
Figure 1: Mean global quality of life scores after completion of radiation therapy according to technique.