title: Impact of intensity-modulated radiotherapy on health-related quality of life for head and neck cancer patients: matched-pair comparison with conventional radiotherapy.
abstract: OBJECTIVE
  To assess the benefit of intensity-modulated radiotherapy (IMRT) compared with conventional RT for the quality of life (QOL) of head and neck cancer survivors.
  
  
  METHODS
  Cross-sectional QOL measures (European Organization for Research and Treatment of Cancer QOL questionnaire C30 and head and neck cancer module) were used with a French multicenter cohort of patients cured of head and neck cancer (follow-up > or = 1 year) who had received bilateral neck RT (> or = 45 Gy) as a part of their initial treatment. We compared the QOL mean scores regarding RT modality (conventional RT vs. IMRT). The patients of the two groups were matched (one to one) according to the delay between the end of RT and the timing of the QOL evaluation and the T stage. Each QOL item was divided into two relevant levels of severity: "not severe" (responses, "not at all" and "a little") vs. "severe" (responses "quite a bit" and "very much"). The association between the type of RT and the prevalence of severe symptoms was approximated, through multivariate analysis using the prevalence odds ratio.
  
  
  RESULTS
  Two comparable groups (67 pairs) were available. Better scores were observed on the head and neck cancer module QOL questionnaire for the IMRT group, especially for dry mouth and sticky saliva (p < 0.0001). Severe symptoms were more frequent with conventional RT concerning saliva modifications and oral discomfort. The adjusted prevalence odds ratios were 3.17 (p = 0.04) for dry mouth, 3.16 (p = 0.02) for sticky saliva, 3.58 (p = 0.02) for pain in the mouth, 3.35 (p = 0.04) for pain in the jaw, 2.60 (p = 0.02) for difficulties opening the mouth, 2.76 (p = 0.02) for difficulties with swallowing, and 2.68 (p = 0.03) for trouble with eating.
  
  
  CONCLUSIONS
  The QOL assessment of head and neck cancer survivors demonstrated the benefit of IMRT, particularly in the areas of salivary dysfunction and oral discomfort.
authors.affiliation: Department of Radiation Oncology, Alexis Vautrin Center, Vandoeuvre-Lès-Nancy, France. p.graff@nancy.fnclcc.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Graff
authors.forename: Michel
authors.initials: M
authors.lastname: Lapeyre
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Desandes
authors.forename: Cécile
authors.initials: C
authors.lastname: Ortholan
authors.forename: René-Jean
authors.initials: RJ
authors.lastname: Bensadoun
authors.forename: Marc
authors.initials: M
authors.lastname: Alfonsi
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.forename: Philippe
authors.initials: P
authors.lastname: Giraud
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.forename: Vincent
authors.initials: V
authors.lastname: Marchesi
authors.forename: Alice
authors.initials: A
authors.lastname: Mège
authors.forename: Didier
authors.initials: D
authors.lastname: Peiffert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011788:Quality of Life; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D011795:Surveys and Questionnaires