Health-related quality of life outcomes in head and neck cancer: results from a prospective, real world data study with Brazilian patients treated with IMRT, conformal and conventional radiation techniques

Head and Neck Cancer

Int J Radiat Oncol Biol Phys. 2020 Sep 29:S0360-3016(20)34346-7. doi: 10.1016/j.ijrobp.2020.09.044. Online ahead of print.


PURPOSE: To compare global health-related quality of life (HRQoL) and overall survival (OS) in patients with head and neck cancer (HNC) treated with intensity-modulated radiotherapy (IMRT), conformal radiotherapy (3DCRT) or conventional radiotherapy (2DRT).

METHODS: In this real-world, multi-institutional and prospective study, HRQoL outcomes were assessed using the EORTC QLQ-C30 and H&N43 questionnaires. Item Response Theory was used to generate a global HRQoL score, based on the 71 questions from both forms. The impact of treatment modality on HRQoL was studied using multivariate regression analyses. Survival was estimated using the Kaplan-Meyer method, and groups were compared by the log-rank test.

RESULTS: Five hundred and seventy patients, from 13 institutions, were included. Median follow-up was 12.2 months. Concerning the radiation technique, 29.5% of the patients were treated with 2DRT, 43.7% received 3DCRT while 26.8% were treated with IMRT. A higher proportion of patients receiving 2DRT had a treatment interruption of more than 5 days (69% vs. 50.2% for 3DCRT and 42.5% for IMRT). IMRT had a statistically significant positive impact on HRQoL compared to 3DCRT (Beta = 2.627, Standard error = 0.804, p = 0.001) while 2DRT had a statistically significant negative impact compared to 3DCRT (Beta = -5.075, Standard error = 0.926, p<0.001). Patients receiving 2DRT presented a worse OS (p = 0.01). There were no differences in OS when IMRT was compared to 3DCRT.

CONCLUSIONS: IMRT provided better HRQoL than 3DCRT which provided better HRQoL than 2DRT. Patients receiving 2DRT presented a worse OS, which might be related to more frequent treatment interruptions.