Intensity Modulated Radiotherapy (IMRT) Combined with Concurrent but not Adjuvant Chemotherapy in Primary Nasopharyngeal Cancer - Outcome and Long-term Toxicity

BackgroundXerostomia is one of the most common adverse events of radiotherapy in head and neck cancer patients. There have been many reports on functional changes of the parotid gland after radiation therapy, but there have been few reports on the volume of the parotid gland and its relationship with oral quality of life (QOL) and even fewer reports on longitudinal change of the parotid gland volume. The purpose of this study was to evaluate the long-term change of the parotid gland volume after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma and the relationship between parotid irradiation dose and xerostomia symptoms.MethodsWe retrospectively analyzed 26 patients with nasopharyngeal cancer treated by IMRT. Longitudinal changes of parotid gland volumes after IMRT were evaluated on CT images. The parotid gland volumes in each period were converted to the ratio to parotid gland volumes before radiotherapy (relative parotid volume). Dunnett’s test was used to evaluate the longitudinal changes in relative parotid volumes at 0-6, 7-18, 19-30, 31-42, 43-54 and 55-66 months after IMRT. We assessed xerostomia 3 years or more after IMRT by measuring the degree of oral moisture using a moisture-checking device (Mucus, Life Co., Ltd.) and oral QOL evaluation by GOHAI (General Oral Health Assessment Index).ResultsThe relative parotid volumes during radiotherapy and at 0-6, 7-18, 19-30, 31-42, 43-54 and 55-66 months after IMRT were 75.2 ± 14.3%, 67.2 ± 11.4%, 68.5 ± 15.9%, 72.4 ± 14.8%, 73.0 ± 13.8%, 76.2 ± 17.5%, and 77.1% ± 17.3%, respectively. The parotid volume had recovered significantly at 43-54 and 55-66 months after IMRT, especially in parotids receiving less than 40 Gy as the mean dose. The mean irradiated dose for bilateral parotids showed negative correlations with oral QOL score and oral moisture after a long period.ConclusionsThe parotid volume recovered gradually but had not reached a plateau even 3 years after radiotherapy, especially in parotids receiving less than 40 Gy as the mean dose.

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The Long-term Recovery of Parotid Glands and Oral QOL in Nasopharyngeal Cancer Treated by Intensity-modulated Radiotherapy

10.21203/rs.3.rs-80119/v1 ◽

2020 ◽

Author(s):

Shun Tasaka ◽

Keiichi Jingu ◽

Noriyoshi Takahashi ◽

Haruo Matsushita ◽

Rei Umezawa ◽

...

Keyword(s):

Head And Neck Cancer ◽

Parotid Gland ◽

Irradiation Dose ◽

Nasopharyngeal Cancer ◽

Intensity Modulated Radiotherapy ◽

Parotid Glands ◽

Intensity Modulated ◽

The Mean ◽

The Relationship

Abstract BackgroundXerostomia is one of the most common adverse events of radiotherapy in head and neck cancer patients. The purpose of this study was to evaluate longitudinal volume the change of parotid gland after radiotherapy for nasopharyngeal cancer and the relationship between parotid irradiation dose and xerostomia symptoms.Methods We retrospectively analyzed longitudinal changing of parotid gland volumes in 20 patients treated by intensity-modulated radiotherapy (IMRT). We assessed xerostomia 4 years or more after IMRT by measuring the degree of oral moisture and oral QOL evaluation.ResultsThe relative parotid volumes at 0-6, 7-18, 19-30, 31-42, 43-54 and 55-66 months after IMRT were67.9 ± 10.1%, 67.7 ± 13.6%, 74.3 ± 12.5%, 75.8 ± 12.4%, 78.3 ± 17.4%, and 75.3% ± 17.7%, respectively. The parotid volume had recovered significantly at 31-42 months after IMRT, especially in parotid receiving less than 40 Gy. The mean irradiated dose for bilateral parotids showed negative correlations with oral QOL score and oral moisture. ConclusionThe mean irradiated dose for the parotid should be reduce as much as possible to improve oral QOL long after IMRT.

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Quality of Life as a Mediator between Cancer Stage and Long-Term Mortality in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Radiotherapy

Cancers ◽

10.3390/cancers13205063 ◽

2021 ◽

Vol 13 (20) ◽

pp. 5063

Author(s):

Kuan-Cho Liao ◽

Hui-Ching Chuang ◽

Chih-Yen Chien ◽

Yu-Tsai Lin ◽

Ming-Hsien Tsai ◽

...

Keyword(s):

Quality Of Life ◽

Global Health ◽

Cancer Patients ◽

Nasopharyngeal Cancer ◽

Intensity Modulated Radiotherapy ◽

Cancer Stage ◽

Intensity Modulated ◽

Long Term Mortality

Background: Quality of life (QoL) attained before, during, or after treatments is recognized as a vital factor associated with therapeutic benefits in cancer patients. This nasopharyngeal cancer (NPC) patient longitudinal study assessed the relationship among QoL, cancer stage, and long-term mortality in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Patients and Methods: The European Organization for Research and Treatment of Cancer (EORTC) core QoL questionnaire (QLQ-C30) and the head and neck cancer-specific QoL questionnaire module (QLQ-HN35) were employed to evaluate four-dimensional QoL outcomes at five time points: pre- (n = 682), during (around 40 Gy) (n = 675), 3 months (n = 640), 1 year (n = 578) and 2 years post-IMRT (n = 505), respectively, for 682 newly diagnosed NPC patients treated between 2003 and 2017 at a single institute. The median followed-up time was 7.5 years, ranging from 0.3 to 16.1 years. Generalized estimating equations, multivariable proportional hazards models, and Baron and Kenny’s method were used to assess the investigated effects. Results: Advanced AJCC stage (III–IV) patients revealed a 2.26-fold (95% CI—1.56 to 3.27) higher covariate-adjusted mortality risk than early-stage (I–II) patients. Compared with during IMRT, advanced-stage patients had a significantly low global health QoL and a significantly high QoL-HN35 symptom by a large magnitude at pre-, 3 months, and 2 years post-IMRT. QoL scales at pre-IMRT, 1 year, and 2 years post-IMRT were significantly associated with mortality. The effect changes of mortality risk explained by global health QoL, QoL-C30, and QoL-HN35 symptom were 5.8–9.8% at pre-IMRT but at 2 years post-IMRT were 39.4–49.4% by global health QoL and QoL-HN35 symptoms. Conclusions: We concluded advanced cancer stage correlates with a long-term high mortality in NPC patients treated with IMRT and the association is partially intermediated by QoL at pre-IMRT and 2 years post-IMRT. Therefore, QoL-HN35 symptom and global health QoL-dependent medical support and care should be focused and tailored at 2 years post-IMRT.

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