Chemoradiotherapy of lung cancer
High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

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Abstract

Background and purpose

Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer leads to a high incidence of severe, mostly esophageal, toxicity. The purpose of this study was to investigate the evolution of quality of life (QoL) in patients with lung cancer, selected for curative radiotherapy (RT) or chemo-RT.

Methods

Seventy-five lung cancer patients completed a longitudinal the EORTC QLQ-C30 and LC13. Linear mixed regression models were fitted to investigate the impact of different factors on overall QoL.

Results

Overall QoL decreased shortly after the end of RT (4 points, p = 0.19), but increased back to baseline within 3 months. Mean scores of role functioning (p = 0.018), cognitive functioning (p = 0.002), dyspnoea (EORTC QLQ-LC13; p = 0.043), dysphagia (p = 0.005) and hoarseness (p = 0.029), showed a significant worsening over time. Emotional functioning (p = 0.033) improved significantly over time.

Severe esophagitis (⩾grade 2) was reported in only 12% of the patients. Next to maximal esophageal toxicity ⩾grade 2 (p = .0.010), also tumor stage IIIA (p < 0.001), tumor stage IIIB (p = 0.003), gender (p = 0.042) and fatigue (p < 0.001) appeared to be significant predictors of QoL.

Conclusion

High-dose radiotherapy or concurrent chemo-radiation in the treatment of lung cancer seems to be a well-tolerated treatment option with preservation of QoL.

Section snippets

Study population and design

We used a longitudinal design to assess different aspects of symptoms and functioning regarding QoL in lung cancer patients treated with high-dose radiotherapy. Patients with small cell lung carcinoma (SCLC) and patients with non-small cell lung carcinoma (NSCLC) selected for curative treatment with high-dose radiotherapy, were asked to participate in this study.

The entry criteria were as follows: cytological or histological proven NSCLC or LD-SCLC with the exclusion of mixed pathology between

Patient characteristics

Patient characteristics are depicted in Table 1. The studied dataset contained 75 patients, of which 19 (25%) were women; 45 patients (60%) had NSCLC and 30 (40%) had SCLC. The mean age of the total group was 67 years (SD 8.8). At 18 months after radiotherapy 45 patients (60%) were alive and without recurrence of disease.

Compliance with QoL assessment

At baseline (before start of radiotherapy) 85% of the patients (n = 64) completed the questionnaire (Table 1). After radiotherapy the compliance rates were 60% at 2 weeks (45 of 75

Discussion

To our knowledge, this is the first prospective QoL study on lung cancer treated with high-dose radiotherapy with or without chemotherapy, including patients with different stages and histology. The only previous study to report on QoL issues after treatment with an accelerated radiotherapy regimen was carried out by Auchter et al. [9], who investigated QoL in 30 NSCLC patients, all stage III. In their conclusion they reported that this aggressive approach did not cause a significant, long-term

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