Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial

• Published in: International journal of radiation oncology, biology, physics Vol. 66; no. 4; pp. 981 - 991
• Main Authors: Pow, Edmond H.N., Kwong, Dora L.W., McMillan, Anne S., Wong, May C.M., Sham, Jonathan S.T., Leung, Lucullus H.T., Leung, W. Keung
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.11.2006
• Subjects: Adult; Aged; CARCINOMAS; CLINICAL TRIALS; Female; HEAD; Humans; Male; Middle Aged; Nasopharyngeal carcinoma; Nasopharyngeal Neoplasms - complications; Nasopharyngeal Neoplasms - radiotherapy; NECK; ORAL CAVITY; PAIN; Parotid sparing; PATIENTS; Pilot Projects; Quality of Life; Radiation Injuries - etiology; Radiation Injuries - prevention & control; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Conformal - adverse effects; Randomized controlled clinical trial; Risk Assessment; Risk Factors; SALIVA; Treatment Outcome; Xerostomia - etiology; Xerostomia - prevention & control; Nasopharyngeal carcinoma; Randomized controlled clinical trial; Radiotherapy; Parotid sparing; Quality of life
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2006.06.013

Purpose: To compare directly the effect of intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) on salivary flow and quality of life (QoL) in patients with early-stage nasopharyngeal carcinoma (NPC). Methods and Materials: Fifty-one patients with T2, N0/N1, M0 NPC took part in a randomized controlled clinical study and received IMRT or CRT. Stimulated whole (SWS) and parotid (SPS) saliva flow were measured and Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core quetionnaire, and EORTC head-and-neck module (QLQ-H&N35) were completed at baseline and 2, 6, and 12 months after radiotherapy. Results: Forty-six patients (88%) were in disease remission 12 months after radiotherapy. At 12 months postradiotherapy, 12 (50.0%) and 20 patients (83.3%) in the IMRT group had recovered at least 25% of preradiotherapy SWS and SPS flow respectively, compared with 1 (4.8%) and 2 patients (9.5%), respectively, in the CRT group. Global health scores showed continuous improvement in QoL after both treatments ( p < 0.001). However, after 12 months subscale scores for role-physical, bodily pain, and physical function were significantly higher in the IMRT group, indicating a better condition ( p < 0.05). Dry mouth and sticky saliva were problems in both groups 2 months after treatment. In the IMRT group, there was consistent improvement over time with xerostomia-related symptoms significantly less common than in the CRT group at 12 months postradiotherapy. Conclusions: IMRT was significantly better than CRT in terms of parotid sparing and improved QoL for early-stage disease. The findings support the case for assessment of health-related QoL in relation to head-and-neck cancer using a site-specific approach.