Concomitant twice-a-day radiotherapy and chemotherapy in unresectable head and neck cancer patients: A long-term quality of life analysis

Authors

  • Nicolas Magné MD,

    Corresponding author
    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
    • Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • Pierre-Yves Marcy MD,

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • Emmanuel Chamorey PhD,

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • Emmanuel Guardiola MD,

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • Xavier Pivot MD, PhD,

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • Maurice Schneider MD,

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • François Demard MD,

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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  • René-Jean Bensadoun MD

    1. Department of Head and Neck Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France
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Abstract

Background

The purpose of this study is to make a comparative analysis between acute toxicity with late toxicity. This study is based upon a French quality of life (QoL) questionnaire in a cohort of advanced head and neck (H&N) cancer patients treated by concomitant twice-a-day continuous radiotherapy with no acceleration and chemotherapy with cisplatin and 5-fluorouracil.

Methods

From September 1992 to November 1997, a prospective data bank of 91 patients was constituted. In November 1999, 31 patients were still alive and followed for more than 3 years. All patients had stage IV strictly unresectable squamous cell carcinoma of oropharynx or hypopharynx. A French specific H&N cancer QoL questionnaire was used at the end of radiotherapy and at the last date of follow-up of each patient (during 1999). p values reflect comparison of percentages obtained at the end of treatment with percentages at long-term follow-up. Statistical analysis was performed using χ2 test (p < .05 considered as significant). Percentages obtained by the QoL questionnaire correspond to moderate-severe problems only.

Results

Twenty-nine of 31 (94%) patients participated in the QoL study. Acute treatment toxicities were severe with declines in virtually all QoL and functional domains. Globally, with an average long-term follow-up of 4.5 years (range 3–7 years after treatment), there is a statistical improvement in the following symptoms: dry mouth and sticky saliva (97% versus 55%, p < .05); tasting problems (35% versus 21%, not significant); swallowing problems (77% versus 36%, p < .05); and H&N pain (86% versus 9%, p < .05). Financial problems were not improved (21% versus 14%, not significant), and psychological problems (59% versus 5%) were statistically significant. Fourteen of 29 (48%) patients were drinking and 8 of 29 (28%) were smoking at long-term follow-up; at the diagnosis they were 86% and 90%, respectively. At long-term follow-up 22 of 29 presented good or very good QoL, and 25 of 29 said they had improved their initial QoL.

Conclusion

The interest of twice-a-day radiotherapy with concomitant chemotherapy is to increase total radiotherapy equivalent dose without increasing late toxicity and also to improve locoregional control, survival, and long-term QoL/effectiveness ratio. Best supportive care is recommended to obtain both good QoL and cancer control in a long-term follow-up. © 2001 John Wiley & Sons, Inc. Head Neck 23: 678–682, 2001.

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