Prospective Analysis Of Patient Reported Symptom Burden After Head And Neck Reirradiation With Intensity Modulated And Stereotactic Body Radiation Therapy

Conformal radiotherapy can potentially reduce risks associated with head and neck (HN) reirradiation but the impact on health-related patient reported outcomes (PRO) is not clear. Here we prospectively analyze patient reported symptom burden after HN reirradiation with intensity modulated radiation therapy (IMRT) and HN stereotactic body radiation therapy (HN-SBRT). Patients prospectively enrolled in our HN reirradiation protocol and treated with IMRT or HN-SBRT from 2013-2015 comprised the cohort. All patients completed the MD Anderson Symptom Inventory–Head and Neck Module (MDASI-HN), a multi-symptom PRO battery that consists of 22 symptom and 6 interference questions assigning a score of 1-10 (10 is most severe). Questionnaires were administered at baseline within 2 weeks of starting treatment, within 2 weeks post-treatment (2W PostTx), 3 months post-treatment (3M PostTx), and 6 months post-treatment (6M PostTx). Patients with recurrences were removed from the study without further analysis. Mean scores were compared using the Student’s T-test. Statistical significance = P ≤ 0.05. Of the 54 patients evaluated, 61% received IMRT and 39% received HN-SBRT. IMRT patients were more likely to receive surgery (33% vs 19%; P < 0.001) and had a higher mean high dose CTV volume (91.3 cc vs 20.6 cc; P < 0.001). Induction and/or concurrent chemotherapy use was not different between IMRT (61%) and HN-SBRT (67%) patients (P > 0.05). All patients (IMRT = 33, HN-SBRT = 21) completed the MDASI survey at baseline and 2W PostTx; 25 (IMRT = 15, HN-SBRT = 10) completed at 3M PostTx; and 13 (IMRT = 8, HN-SBRT = 5) completed at 6M PostTx. There were no differences in symptom and interference scores at baseline between patients treated with IMRT vs. HN-SBRT. At 2W PostTx, patients treated with IMRT reported higher mean pain (3.8±0.52 vs 2.1±0.61, P = 0.039) and fatigue (4.5±0.48 vs 2.7±0.68, P = 0.026) scores, and a trend for higher mouth/throat sores (3.5±0.61 vs 1.7±0.64, P = 0.052). At 3M PostTx, patients treated with IMRT reported higher mean sadness (2.07±0.69 vs 0.40±0.22, P = 0.035). At the 6M PostTx, IMRT patients reported higher drowsiness (2.13±0.83 vs 0.0±0.0, P = 0.038), teeth/gum problems (1.63±0.65 vs 0.0±0.0, P = 0.042), mouth/throat sores (2.13±0.67 vs 0.0±0.0, P = 0.015), and interference with activity (2.0±0.71 vs 0.20±0.20, P= 0.040). At 6M PostTx, scores decreased from baseline in HN-SBRT patients and increased from baseline in IMRT patients except for interference with activity which decreased from baseline in both cohorts. Preliminary findings demonstrate a favorable symptom burden profile after HN-SBRT reirradiation in the immediate post-treatment setting. The impact of treatment volume, dose, and modality on these measures are the subject of further investigation.