Long-term disease-specific and cognitive quality of life after intensity-modulated radiation therapy: a cross-sectional survey of nasopharyngeal carcinoma survivors.
BACKGROUND
There is a lack of data on quality of life in long-term survivors of nasopharyngeal carcinoma (NPC) who have been treated with intensity-modulated radiation therapy (IMRT). We characterized long-term disease-specific and cognitive QoL in NPC survivors after IMRT.


METHODS
We conducted a cross-sectional study of surviving patients diagnosed and treated for NPC at our center with curative-intent IMRT, with or without chemotherapy. Patients who were deceased, still undergoing treatment, with known recurrent disease, or treated with RT modality other than IMRT were excluded. QoL was measured by FACT-NP and FACT-Cog.


RESULTS
Between May and November 2013, 44 patients completed cognitive (FACT-Cog), general (FACT-G), and NPC-specific (NPCS) QoL assessments. Patients were categorized into 4 cohorts based on duration since IMRT (≤2.5, >2.5-6, >6-10, and >10-16 years). There was no significant difference in age (p = 0.20) or stage ((I/II vs III/IV: p = 0.78) among the cohorts. The 4 cohorts differed overall for all QoL measures (ANOVA: p < 0.02 for each), due to improved scores >2.5-6 years post-IMRT compared with ≤2.5 years post-IMRT (post hoc tests: p ≤ 0.04 for each). No differences were observed between >2.5-6 and >6-10 years post-IMRT, but lower mean FACT-Cog and NPCS scores were observed for >10 years compared to >2.5-6 years post-IMRT (post hoc: p < 0.05 for each).


CONCLUSIONS
All QoL measures were low during the initial recovery period (≤2.5 years) and were higher by 6 years post-IMRT. At >10 years post-IMRT, lower scores were observed in the domains of NPC-specific and cognitive QoL. Survivors of NPC, even if treated with IMRT, are at risk for detriment in domain-specific QoL measures at very long-term follow-up.
Department of Radiation Oncology, University of California, San Francisco, USA.
Alan
A
Kiang
Department of Radiation Oncology, University of California, San Francisco, USA.
Vivian K
VK
Weinberg
Department of Radiation Oncology, University of California, San Francisco, USA.
Ka Ho Nicholas
KH
Cheung
Department of Radiation Oncology, University of California, San Francisco, USA.
Erin
E
Shugard
Department of Radiation Oncology, University of California, San Francisco, USA.
Josephine
J
Chen
Department of Radiation Oncology, University of California, San Francisco, USA.
Jeanne M
JM
Quivey
Department of Radiation Oncology, University of California, San Francisco, USA. yoms@radonc.ucsf.edu.|Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero St, MZ Bldg R H1031, Box 1708, San Francisco, CA, 94143-1708, USA. yoms@radonc.ucsf.edu.
Sue S
SS
Yom
Cognitive quality of life; Functional assessment of cancer therapy (FACT); General quality of life; Intensity-modulated radiation therapy (IMRT); Nasopharyngeal carcinoma (NPC)
J Clin Exp Neuropsychol. 1998 Oct;20(5):684-93
10079044
Am J Clin Oncol. 2007 Jun;30(3):271-7
17551304
Radiother Oncol. 2011 Apr;99(1):1-5
21459468
Neuro Oncol. 2013 Oct;15(10):1429-37
23956241
J Neurol Neurosurg Psychiatry. 1989 Apr;52(4):488-92
2786925
Curr Drug Targets. 2010 Nov;11(11):1413-22
20583976
Radiat Res. 2012 Jul;178(1):46-56
22687052
Science. 2003 Dec 5;302(5651):1760-5
14615545
PLoS One. 2012;7(6):e36529
22701557
Acta Oncol. 2004;43(2):153-60
15163163
Int J Radiat Oncol Biol Phys. 2009 Nov 1;75(3):870-7
19801103
J Neuropsychiatry Clin Neurosci. 2003 Winter;15(1):90-7
12556578
Arch Neurol. 2000 Sep;57(9):1347-52
10987903
Clin Cancer Res. 2013 May 1;19(9):2294-300
23388505
J Clin Oncol. 2006 Mar 20;24(9):1415-20
16549835
Lancet Oncol. 2012 Jun;13(6):568-9
22560813
Arch Otolaryngol Head Neck Surg. 2000 Apr;126(4):517-21
10772307
Cancer. 2003 Apr 15;97(8):2019-26
12673733
J Clin Oncol. 2007 Sep 10;25(26):4096-103
17827459
Int J Radiat Oncol Biol Phys. 2005 Nov 1;63(3):725-31
16199308
Am J Clin Oncol. 2011 Oct;34(5):478-82
21537150
Neuropsychol Rehabil. 2016;26(3):392-409
25947039
Int J Radiat Oncol Biol Phys. 1997 Jun 1;38(3):667-72
9231693
Int J Radiat Oncol Biol Phys. 2003 May 1;56(1):83-8
12694826
Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):6-9
17189061
Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):499-505
19084353
Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):722-6
20044217
J Clin Oncol. 2015 May 20;33(15):1653-9
25897156
Psychooncology. 2009 Jun;18(6):606-14
18942661
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1528-33
22284690
Cancer. 2009 Jun 15;115(12):2605-16
19309747