IMRT Provides Better QoL in Head and Neck Cancer

January 31, 2012 (Phoenix, Arizona) — Treatment with intensity-modulated radiation therapy (IMRT) provides head and neck cancer patients with a better long-term quality of life (QoL) than older radiation technology, according to researchers.

Patients with locally advanced disease treated with IMRT were found to have a "significantly" better QoL at 1 and 2 years than patients treated with 3-dimensional conformal radiotherapy (3DCRT), said lead study author Allen Chen, MD, from the University of California Davis School of Medicine in Sacramento. He spoke about the 155-patient study at a press conference at the 2012 Multidisciplinary Head and Neck Cancer Symposium.

The mean global QoL scores were 67.5 and 80.1 (out of a possible 100) for the IMRT patients at 1 and 2 years, respectively, compared with 55.4 and 57.0, respectively, for the 3DCRT patients (P < .001).

Dr. Chen pointed out that QoL improvements associated with IMRT became more pronounced over the study period.

One year after radiation treatment, the proportion of patients who rated their global QoL as "very good" or "outstanding" was 51% in those treated with IMRT and 41% in those treated with 3DCRT (P = .11). However, after 2 years, the corresponding percentage of patients increased to 73% and 49%, respectively (P < .001).

In the United States, the "vast majority" of head and neck cancer patients are treated with IMRT, said Dr. Chen. Nonetheless, which treatment is better is a "loaded question," he said, because neither has been shown to provide superior survival or cure rates in these patients. But emerging data, including from this study, indicate that IMRT is less toxic. As a result, "one could consider it as the standard of care," he said.

Dr. Chen admitted that he spends "a lot of time on the phone with insurance companies" justifying the choice of IMRT.

First Long-term Study of QoL

This study is the first to measure long-term QoL in head and neck cancer patients treated with various forms of radiation therapy, according to meeting press materials.

As part of the study, Dr. Chen and colleagues performed a multivariate analysis to "examine all of the potential variables that could have influenced quality of life."

IMRT "emerged convincingly" as the only variable independently associated with improved QoL (P = .01), said Dr. Chen. The other variables in the analysis included sex, age, radiation intent (definitive vs postoperative), radiation dose, tumor stage, primary site, use of concurrent chemotherapy, and neck dissection.

The QoL questionnaire used in the study asked patients about a range of symptoms and issues. The scores revealed that the benefit of IMRT was most pronounced for salivary function.

Two years after radiation treatment, patients treated with IMRT reported a score of 77.3 for their salivary function, compared with 53.0 reported by patients treated with 3DCRT (P < .001).

Salivary function is an especially important measure, said Dr. Chen, because it can be an ongoing "nuisance" and serve as a "daily reminder of one's cancer, even years later," he said.

The study did not include any measure of gastronomy tube dependence, observed David Raben, MD, from the University of Colorado in Aurora, who moderated the press conference.

In a press statement, Dr. Chen suggested that the potential trauma associated with treatment for head and neck cancer has come a long way. "Radiation therapy for head and neck cancer is without a doubt an intensive process, and very intimidating to most patients. Folks think about the prospect of 6 to 7 weeks of radiation and naturally expect the worst. It is nice to know that technological advances have made the treatment much more tolerable than in the past," he said.

Study Details

The University of Washington QoL instrument is routinely used at the University of California Davis to assess patient progress and satisfaction. The QoL scores were retrospectively reviewed for 155 patients with squamous cell carcinomas of the head and neck requiring bilateral neck irradiation for locally advanced disease. The study was limited to patients who were clinically without evidence of recurrent disease and had at least 2 years of follow-up.

According to the study abstract, 82 patients (53%) were treated with definitive radiation therapy and 73 (47%) were treated postoperatively. Eighty-four patients (54%) were treated with IMRT that included an extended field to reach the low neck. The remaining 71 patients (46%) were treated with 3DCRT using opposed lateral fields matched to a low anterior neck field. Concurrent chemotherapy was administered with radiation therapy in 73 patients (47%).

The study authors have disclosed no relevant financial relationships.

2012 Multidisciplinary Head and Neck Cancer Symposium (MHNCS): Abstract 148. Presented January 26, 2012.