Health-related quality of life outcomes in head and neck cancer : results from a prospective, real-world data study with Brazilian patients treated with intensity modulated radiation therapy, conformal and conventional radiation techniques

Abstract

Purpose: To compare global health-related quality of life (HRQoL) and overall survival (OS) in patients with head and neck cancer treated with intensity modulated radiation therapy (IMRT), conformal radiation therapy (3DCRT) or conventional ra- diation therapy (2DRT). Methods and Materials: In this real-world, multi-institutional and prospective study, HRQoL outcomes were assessed using the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Head and Neck 43 (H&N43) questionnaires. Item response theory was used to generate a global HRQoL score, based on the 71 questions from both forms. The effect of treatment modality on HRQoL was studied using multivariate regression analyses. Survival was estimated using the Kaplan-Meyer method, and groups were compared by the log-rank test. Results: Five hundred and seventy patients from 13 institutions were included. Median follow-up was 12.2 months. Concern- ing the radiation technique, 29.5% of the patients were treated with 2DRT, 43.7% received 3DCRT, and 26.8% were treated with IMRT. A higher proportion of patients receiving 2DRT had a treatment interruption of more than 5 days (69% vs 50.2% for 3DCRT and 42.5% for IMRT). IMRT had a statistically significant positive effect on HRQoL compared with 3DCRT (bZ 2.627, standard error Z 0.804, P Z .001) and 2DRT had a statistically significant negative effect compared with 3DCRT (bZ 5.075, standard error Z 0.926, P < .001). Patients receiving 2DRT presented a worse OS (P Z .01). There were no differences in OS when IMRT was compared with 3DCRT. Conclusions: IMRT provided better HRQoL than 3DCRT, which provided better HRQoL than 2DRT. Patients receiving 2DRT presented a worse OS, which might be related to more frequent treatment interruptions. Ó 2020 Elsevier Inc. All rights reserved