Edvard Abel - Effects on quality of life of new radiotherapy techniques in treatment of head and neck cancer

Link directly to the doctoral thesis

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Abstract

The treatment of head and neck cancer (HNC) with radiotherapy has greatly evolved during the last twenty-five years with the introduction of new algorithms and techniques such as three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT).

The aim of this thesis was to investigate short- and long-term effects of new radiation therapy techniques on patients’ quality of life and contribute to the implementation of the results in the everyday clinical care for these patients.

In a longitudinal study health-related quality of life (HRQOL) questionnaires were used to prospectively study patient-reported outcome measures (PROM) in patients with advanced HNC treated with IMRT versus 3D-CRT. We found better HRQOL scores regarding symptoms such as dry mouth and head and neck-specific pain as well as functional aspects, like cognitive functioning and sexuality, favoring the IMRT group.

In a five-year follow-up of HNC patients treated with IMRT, most HRQOL domains returned to baseline values with exception of local symptoms like dry mouth, taste alterations and problems with teeth. A comparison with an age and sex matched cohort from the normal population showed even more HRQOL effects in the treated patients.

Cancer-related fatigue (CRF) was evaluated in the same group of patients with a fatigue-specific HRQOL questionnaire. A significant increase of CRF within the first three months after start of treatment was found. CRF scores returned to baseline values within twelve months. Radiation mean dose to the cerebellum, age < 60 years, lower performance status and lower tumor stage were predictive for higher levels of CRF.

Illustrations from the thesis:
Example that illustrate the difference in dose distribution between conventional radiotherapy and Intensity Modulated Radiotherapy MRT. Note 3D-CRT plan (left) vs IIMRT plan (right). Notice how the spinal cord and left parotid gland are better spared and how the high dose is better shaped around the PTV (arrows). Figure 3, page 11 in the thesis.