Impact Of Radiotherapy Technique On Quality Of Life In Head And Neck Cancer Patients, In Brazil: Prospective Real-World Data Study

To compare global quality of life (QOL) and overall survival (OS) in patients with head and neck cancer treated curatively with chemoradiotherapy using IMRT, 3DCRT, or 2DRT techniques. In this real-world, multi-institutional and prospective study, QOL outcomes were assessed using EORTC QLQ-C30 and EORTC QLQ-H&N43 questionnaires. Patients were treated according to each participating institution’s protocol. The Item Response Theory was used to generate a global QOL score, based on the 71 questions of both forms. The impact of the treatment modality on QOL was analyzed using multivariate regression analyses. Survival was calculated using Kaplan-Meier method, and groups were compared by the log-rank test. Four hundred and eight two patients with head and neck cancer located in oral cavity (29.0%), oropharynx (35.5%), hypopharynx (7.6%), nasopharynx (3.3%), larynx (21.4%) and with unknown primary site (3.2%), in clinical stage II (7.1%), III (26.1%) or IV (66.8%), completed the questionnaires at the baseline (pre-treatment) and every three months, thereafter. Median follow up was 10.2 months. Concerning radiation technique, 31.4% of the patients were treated with 2DRT, 36.5% received 3DCRT while 32.1% were treated with IMRT. A higher proportion of patients receiving 2DRT had a treatment interruption of more than 10 days (42.8%) when compared to the other techniques (28% for 3DCRT and 19.8% for IMRT). A decrease in QOL during treatment was observed in all patients’ groups. In our model, IMRT had a statistically significant positive impact on QOL in relation to 3DCRT (Beta=2.01, Standard Error= 1.27, p = 0.0366) while 2DRT had a statistically significant negative impact compared to 3DCRT (Beta=-3.29, Standard Error= 1.07, p = 0.0023). Patients receiving 2DRT presented a worse OS (p=0,01). There were no differences in OS when IMRT was compared to 3DCRT. We observed, as expected, a decrease in QOL after treatment, but patients presented an improvement thereafter, with QOL reaching levels similar to the baseline after 9 months of follow-up. IMRT provided better QOL than 3DCRT which provided better QOL than 2DRT. Patients receiving 2DRT presented a worse OS, which may be related to larger treatment interruptions.