International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationLong-Term Quality of Life After Swallowing and Salivary-Sparing Chemo–Intensity Modulated Radiation Therapy in Survivors of Human Papillomavirus–Related Oropharyngeal Cancer
Introduction
Concomitant chemo-radiation therapy (CRT) is considered standard-of-care treatment for organ preservation in patients with locally advanced head and neck cancer (HNC). Traditionally, CRT using conventional radiation therapy was associated with significant morbidity. Xerostomia and dysphagia in particular have been identified as the primary determinants of health-related quality of life (HRQOL) in long-term survivors of HNC 1, 2. Advances in radiation therapy planning with intensity modulated radiation therapy (IMRT) in recent years have enabled selective sparing of structures critical for salivary production and swallowing 3, 4, which have translated into improvements in xerostomia, dysphagia, and global HRQOL 5, 6, 7, 8.
We previously reported 2-year results of a prospective study of IMRT designed to spare the swallowing structures in patients with locally advanced oropharyngeal cancer (OPC) receiving CRT, which demonstrated very low rates of patient- and observer-rated dysphagia and percutaneous endoscopic gastrostomy (PEG) tube dependence while maintaining high rates of locoregional control and overall survival (8). Although the 2-year outcomes are encouraging, long-term HRQOL after IMRT remains scarcely reported, and concerns remain regarding radiation therapy–related complications that may manifest several years after CRT and thereby compromise HRQOL in long-term survivors 9, 10. Herein we report long-term HRQOL outcomes in patients with locally advanced OPC treated with definitive CRT using IMRT specifically aimed to spare the salivary and swallowing structures.
Section snippets
Patients and treatment
Between May 2003 and January 2011, 93 patients were enrolled on 2 consecutive prospective institutional review board–approved studies of swallowing and salivary organ-sparing chemo-IMRT for locally advanced OPC. Patient eligibility and treatment in both protocols were as previously detailed 8, 11. Patients with newly diagnosed, nonmetastatic stage III or IV OPC without posterior pharyngeal wall involvement or distant metastases were eligible for the original parent studies. Patients who
Patient characteristics
Sixty-nine patients who were alive and without recurrence/second primary cancer met eligibility for the present study. Forty (58%) responded to the mailed questionnaires. Of the nonrespondents, 12 were unable to be reached and 17 elected to not participate. A comparison of T and N stages of patients in the parent studies, those eligible for the present study, and those who participated in the present study is provided in Table e1 (available online at www.redjournal.com). Possible attrition bias
Discussion
The present study demonstrates that chemo-IMRT intended to spare the swallowing and salivary structures in patients with locally advanced OPC can achieve highly encouraging long-term patient-reported HRQOL, with overall and most HN-specific symptoms showing stability or continued improvement after 2 years. Compared with before treatment, the overall cohort experienced clinically meaningful improvement in HNQOL Emotion and Overall Bother domain scores at long-term follow-up, stable HNQOL summary
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J.M.V. and D.H.M. contributed equally to this work.
J.M.V.'s present address is Emory University School of Medicine, Winship Cancer Institute, Department of Radiation Oncology, Atlanta, GA.
This study was supported in part by National Institutes of Health grant PO1 CA59827 and the Newman Family Foundation.
Conflict of interest: none.