Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Abstract

BACKGROUND.It was reported previously that the dosimetric superiority of conformal radiotherapy (RT), either 3‐dimensional conformal RT (3D‐CRT) or intensity‐modulated RT (IMRT), over conventional 2D‐RT translated into clinical benefits for patients with nasopharyngeal carcinoma (NPC). In this study, the authors compared quality‐of‐life (QOL) outcomes of NPC survivors who received treatment with 1 of 4 different RT techniques at a single institute during different periods.METHODS.The authors analyzed QOL data of from 237 patients with NPC who were cancer free for 2 or 3 years when their QOL was assessed. The study population included 152 patients who received conventional RT (2D‐RT, 61 patients; 2D‐RT plus 3D‐CRT boost, 91 patients) and 85 patients who received conformal RT (3D‐CRT, 33 patients; IMRT, 52 patients). The European Organization for the Research and Treatment of Cancer (EORTC) Core QOL questionnaire and the EORTC Head and Neck QOL questionnaire were completed.RESULTS.Compared with patients who received with conventional RT, patients who received conformal RT had both statistically (P < .05) and clinically (a difference in mean scores ≥10 points) significant improvements in the scales of global QOL, pain, appetite loss, senses, speech, social eating, teeth, opening mouth, xerostomia, sticky saliva, and feeling ill. No significant difference was observed in any of the scales that compared 2D‐RT with 2D‐RT plus 3D‐CRT boost or that compared 3D‐CRT with IMRT. Survivors who received conformal RT had a 2.01‐fold higher probability (odds ratio [OR], 2.01; 95% confidence interval [95% CI], 1.19–3.68) of reporting good global QOL and a 2.70‐fold lower probability (OR, 0.37; 95% CI, 0.20–0.66) of reporting a high level of xerostomia than survivors who received conventional RT.CONCLUSIONS.Conformal RT substantially improved head and neck‐related symptoms and broad aspects of QOL for survivors of NPC. Cancer 2007. © 2006 American Cancer Society.

Submandibular salivary gland transfer for the prevention of radiation‐induced xerostomia in patients with nasopharyngeal carcinoma: 5‐Year outcomes

“…Several strategies, such as systemic amifostine, [22][23][24][25] IMRT, [26][27][28][29] pilocarpine, [30][31][32][33][34][35][36] and the salivary gland transfer procedure reported by Seikaly and Jha and their respective colleagues, 8,9,13 have been tried over the years in attempts to reduce xerostomia. IMRT strategies have focused primarily on saving 1 or both of the parotid glands.…”

“…IMRT strategies have focused primarily on saving 1 or both of the parotid glands. [26][27][28][29] Investigators are now, however, focusing their attention on the importance of submandibular salivary gland salivary contributions. The use of amifostine has decreased the incidence of xerostomia during radiotherapy in patients with head and neck cancer in a few randomized studies.…”

Phase III randomized study: Oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation‐induced xerostomia

“…[10][11][12][13] Investigators are now, however, focusing their attention on the importance of submandibular salivary gland salivary contributions. Eisbruch et al are investigating the possibility of sparing both the parotid and the submandibular salivary gland by the combined use of intensity-modulated radiation therapy (for parotids) and Amifostine for the cytoprotection of the submandibular salivary gland.…”

“…[2][3][4][5] Xerostomia impairs mastication, deglutition, gustation, and causes nutritional compromise, sleep disruptions, and change in oral microbial flora leading to caries. 4,5 Several strategies such as systemic Amifostine, [6][7][8][9] intensity-modulated radiation treatment (IMRT), [10][11][12][13] pilocarpine (Salagen, Pfizer Canada, Mississauga, Ontario), [14][15][16][17][18][19][20] acupuncture, 12 and Seikaly-Jha salivary gland transfer (SGT) procedure [22][23][24] have been tried over the years in an attempt to reduce xerostomia.…”

Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

“…Compared with conventional 2D techniques and 3D crt, imrt can provide superior dose coverage to the tumour and better sparing of surrounding tissues, potentially improving local control and long-term survival and, more importantly, enhancing qol for these patients 40,41 . Hisung et al 42 reported that, compared with 5-field 3D crt, 5-to 7-field imrt distinctly reduced radiation in the brain stem by about 16%.…”