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

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Abstract

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 χ 2 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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