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

Purpose: 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.