Intensity-modulated radiotherapy is associated with improved global quality of life among long-term survivors of head-and-neck cancer.
OBJECTIVE
To compare the long-term quality of life among patients treated with and without intensity-modulated radiotherapy (IMRT) for head-and-neck cancer.


METHODS
The University of Washington Quality of Life instrument scores were reviewed for 155 patients previously treated with radiation therapy for locally advanced head-and-neck cancer. All patients were disease free and had at least 2 years of follow-up. Eighty-four patients (54%) were treated with IMRT. The remaining 71 patients (46%) were treated with three-dimensional conformal radiotherapy (3D CRT) by use of initial opposed lateral fields matched to a low anterior neck field.


RESULTS
The mean global quality of life scores were 67.5 and 80.1 for the IMRT patients at 1 and 2 years, respectively, compared with 55.4 and 57.0 for the 3D CRT patients, respectively (p < 0.001). At 1 year after the 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 sex, age, radiation intent (definitive vs. 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).


CONCLUSIONS
The early quality of life improvements associated with IMRT not only are maintained but apparently become more magnified over time. These data provide powerful evidence attesting to the long-term benefits of IMRT for head-and-neck cancer.
Department of Radiation Oncology, University of California Davis Cancer Center, Sacramento, CA 95817, USA. allen.chen@ucdmc.ucdavis.edu
Allen M
AM
Chen
D Gregory
DG
Farwell
Quang
Q
Luu
Esther G
EG
Vazquez
Derick H
DH
Lau
James A
JA
Purdy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058996:Quality Improvement / Q000592:standards; D011788:Quality of Life; D020266:Radiotherapy, Conformal / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards*; D017741:Survivors; D055815:Young Adult