title: Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy.
abstract: OBJECTIVE
  To investigate the impact of treatment-related toxicity on health-related quality of life (HRQoL) among patients with head and neck squamous cell carcinoma treated with radiotherapy either alone or in combination with chemotherapy or surgery.
  
  
  METHODS
  The study sample was composed of 425 disease-free patients. Toxicity was scored according to the European Organisation for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) late radiation-induced morbidity scoring system. HRQoL was assessed using the EORTC Quality of Life Questionnaire C30. These assessments took place at 6, 12, 18, and 24 months after completion of radiotherapy. The analysis was performed using a multivariate analysis of variance.
  
  
  RESULTS
  Of the six RTOG scales investigated, two significantly affected self-reported HRQoL, salivary gland (RTOG(xerostomia)) and esophagus/pharynx (RTOG(swallowing)). Although RTOG(xerostomia) was reported most frequently, HRQoL was most affected by RTOG(swallowing), particularly in the first 18 months after completion of radiotherapy.
  
  
  CONCLUSIONS
  Late radiation-induced toxicity, particularly RTOG(swallowing) and RTOG(xerostomia), has a significant impact on the more general dimensions of HRQoL. These findings suggest that the development of new radiation-induced delivery techniques should not only focus on reduction of the dose to the salivary glands, but also on anatomic structures that are involved in swallowing.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Groningen, the Netherlands. j.a.langendijk@rt.umcg.nl
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.forename: Irma M
authors.initials: IM
authors.lastname: Verdonck-de Leeuw
authors.forename: Charles R
authors.initials: CR
authors.lastname: Leemans
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003679:Deglutition / Q000528:radiation effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology* / Q000503:physiopathology; D011878:Radiotherapy / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014987:Xerostomia / Q000209:etiology