PROSPECTIVE STUDY TO EXPLORE THE RELATIONSHIP BETWEEN DOSIMETRIC PATTERN AND QUALITY OF LIFE IN HEAD AND NECK CANCER PATIENTS TREATED BY IMRT

TARUN NANDA; YASHVI; HARTANYA BHAMRA; ANKUR SHARMA; PRANAM A.

doi:10.22159/ijcpr.2024v16i5.5002

Authors

TARUN NANDA Department of Radiotherapy and Oncology, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
YASHVI Department of Radiotherapy and Oncology, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
HARTANYA BHAMRA Department of Radiotherapy and Oncology, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
ANKUR SHARMA Department of Radiotherapy and Oncology, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
PRANAM A. Department of Community Medicine, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.22159/ijcpr.2024v16i5.5002

Keywords:

Head and neck cancer, Quality of life, Intensity-modulated radiotherapy, Dosimetric patterns, Radiation toxicity

Abstract

Objective: This prospective study aimed to explore the relationship between dosimetric patterns and quality of life (QOL) outcomes in patients with head and neck cancer (HNC) treated with Intensity-Modulated Radiotherapy (IMRT).

Methods: Conducted at the Department of Radiation Oncology, RNTMC, Udaipur, Rajasthan, from January to December 2023, this hospital-based observational study included 100 patients with histologically confirmed squamous cell carcinoma of the head and neck. Patients underwent IMRT with specific dosimetric parameters targeting various structures while assessing QOL using the EORTC QLQ-C30 and QLQ-HN-35 questionnaires at baseline, 3, and 6 mo post-treatment.

Results: The study encompassed predominantly male patients (89%) with a mean age of 53.02±13.10 y. Tongue cancer was the most common site (38%), followed by oropharynx (16%) and buccal mucosa (14%). Dosimetric analysis revealed that higher mean doses to the left and right parotid glands and constrictor muscles were significantly associated with increased severity of symptoms, impacting QOL negatively. Notably, increased mean doses correlated with more severe issues related to pain, swallowing, sensory problems, speech, and social aspects of eating and contact.

Conclusion: This study underscores the critical impact of dosimetric patterns on the QOL of HNC patients treated with IMRT. Optimizing dosimetric parameters to minimize exposure to critical structures like the parotid glands and constrictor muscles can potentially mitigate treatment-related toxicities, thus enhancing patients' QOL. Future strategies should focus on tailored radiation therapy plans to balance tumor control and preservation of QOL.

Downloads

Download data is not yet available.

References

WHO, IARC. Latest global cancer data: cancer burden rises to 18.1 million new cases and 9.6 million cancer deaths in 2020 press release. Geneva Switzerland; 2020.

Prabhash K, Babu G, Chaturvedi P, Kuriakose M, Birur P, Anand AK. Indian clinical practice consensus guidelines for the management of very advanced disease of squamous cell carcinoma of head and neck. Indian J Cancer. 2020;57Suppl:S22-5. doi: 10.4103/0019-509X.278977, PMID 32167069.

Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Pineros M. Estimating the global cancer incidence and mortality in 2018: globocan sources and methods. Int J Cancer. 2019;144(8):1941-53. doi: 10.1002/ijc.31937, PMID 30350310.

Hashibe M, Brennan P, Benhamou S, Castellsague X, Chen C, Curado MP. Alcohol drinking in never users of tobacco cigarette smoking in never drinkers and the risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. J Natl Cancer Inst. 2007;99(10):777-89. doi: 10.1093/jnci/djk179, PMID 17505073.

Kelly C, Paleri V, Downs C, Shah R. Deterioration in quality of life and depressive symptoms during radiation therapy for head and neck cancer. Otolaryngol Head Neck Surg. 2007;136(1):108-11. doi: 10.1016/j.otohns.2006.06.1278, PMID 17210344.

Wijers OB, Levendag PC, Braaksma MM, Boonzaaijer M, Visch LL, Schmitz PI. Patients with head and neck cancer cured by radiation therapy: a survey of the dry mouth syndrome in long term survivors. Head Neck. 2002;24(8):737-47. doi: 10.1002/hed.10129, PMID 12203798.

Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK. Mucositis incidence severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66(3):253-62. doi: 10.1016/s0167-8140(02)00404-8, PMID 12742264.

Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12(2):127-36. doi: 10.1016/S1470-2045(10)70290-4, PMID 21236730.

Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76(3)Suppl:S58-63. doi: 10.1016/j.ijrobp.2009.06.090, PMID 20171519.

Portaluri M, Fucilli FI, Castagna R, Bambace S, Pili G, Tramacere F. Three-dimensional conformal radiotherapy for locally advanced (stage ii and worse) head and neck cancer: dosimetric and clinical evaluation. Int J Radiat Oncol Biol Phys. 2006;66(4):1036-43. doi: 10.1016/j.ijrobp.2006.03.014, PMID 16750321.

Saarilahti K, Kouri M, Collan J, Hamalainen T, Atula T, Joensuu H. Intensity-modulated radiotherapy for head and neck cancer: evidence for preserved salivary gland function. Radiother Oncol. 2005;74(3):251-8. doi: 10.1016/j.radonc.2004.11.004, PMID 15763305.

Mendenhall WM. Mandibular osteoradionecrosis. J Clin Oncol. 2004;22(24):4867-8. doi: 10.1200/JCO.2004.09.959, PMID 15520050.

Bhide SA, Harrington KJ, Nutting CM. Otological toxicity after postoperative radiotherapy for parotid tumours. Clin Oncol (R Coll Radiol). 2007;19(1):77-82. doi: 10.1016/j.clon.2006.11.007, PMID 17305258.

Hammerlid E, Taft C. Health-related quality of life in long term head and neck cancer survivors: a comparison with general population norms. Br J Cancer. 2001;84(2):149-56. doi: 10.1054/bjoc.2000.1576, PMID 11161369.

Abel E, Silander E, Nyman J, Bjork Eriksson T, Hammerlid E. Long-term aspects of quality of life in head and neck cancer patients treated with intensity modulated radiation therapy: a 5 y longitudinal follow up and comparison with a normal population cohort. Adv Radiat Oncol. 2020 Jan-Feb;5(1):101-10. doi: 10.1016/j.adro.2019.07.015, PMID 32051896.

Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh Laskar S. Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: a randomized controlled trial. Radiother Oncol. 2012;104(3):343-8. doi: 10.1016/j.radonc.2012.07.001, PMID 22853852.

Ghosh Laskar S, Yathiraj PH, Dutta D, Rangarajan V, Purandare N, Gupta T. Prospective randomized controlled trial to compare 3-3-dimensional conformal radiotherapy to intensity modulated radiotherapy in head and neck squamous cell carcinoma: long term results. Head Neck. 2016;38Suppl 1:E1481–7. doi: 10.1002/hed.24263.