title: Quality-of-life (QOL) outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiation therapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT): evidence from a prospective randomized study.
abstract: OBJECTIVE
  To prospectively evaluate and compare health-related quality-of-life (QOL) outcomes in patients with head-neck squamous cell carcinoma randomized to either intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) and assess serial longitudinal change in QOL over time.
  
  
  METHODS
  QOL outcomes were assessed using the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (QLQ-C30) and Head-Neck module (HN-35) at baseline (pre-treatment) and subsequently periodically on follow-up. Mean scores of individual domains/scales of 3D-CRT and IMRT were compared using 't' test at each time point; while longitudinal change in mean scores of both groups over time was evaluated by repeated measurement analysis of variance.
  
  
  RESULTS
  Fifty eight of the 60 randomized patients who filled the QOL questionnaire at least at one time point were included in the analysis. Several general (emotional functioning, role functioning, social contact) as well as head and neck cancer-specific (dry mouth, opening mouth, sticky saliva, pain, senses) QOL domains were better preserved with IMRT compared to 3D-CRT at different time points. Importantly, none of the QOL domains were worse with IMRT at any time point. There was substantial deterioration in QOL scores immediate post-treatment (3-months) in both arms. However, QOL scores gradually but definitely improved over time for most domains. Global QOL, emotional/role functioning, nausea/vomiting, pain, swallowing, speech, social contact/eating, insomnia showed rapid recovery (<6months) while physical/cognitive functioning, dry mouth, sticky saliva, fatigue, senses showed delayed recovery (>6months). There were no significant differences in loco-regional or survival between the two arms.
  
  
  CONCLUSIONS
  There is substantial deterioration in QOL after curative-intent head-neck irradiation that gradually improves over time. IMRT results in clinically meaningful and statistically better QOL scores for some domains compared to 3D-CRT at several time points with comparable disease outcomes that could support its widespread adoption in routine clinical practice.
authors.affiliation: Department of Radiation Oncology, Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Hospital, Tata Memorial Centre, Kharghar, Navi Mumbai, Mumbai, India.
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Rathod
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Jaiprakash
authors.initials: J
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000503:physiopathology* / Q000532:radiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D016896:Treatment Outcome