Long Term Late Toxicity, Quality Of Life and Emotional Distress In Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy

Publication date: Available online 4 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lachlan J. McDowell, Kathy Rock, Wei Xu, Biu Chan, John Waldron, Lin Lu, Shereen Ezzat, David Pothier, Lori J. Bernstein, Nathaniel So, Shao Hui Huang, Meredith Giuliani, Andrew Hope, Brian O'Sullivan, Scott V. Bratman, John Cho, John Kim, Raymond Jang, Andrew Bayley, Jolie Ringash
PurposeTo report long-term (> 4 year) toxicity and quality of life (QOL) in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) in a non-endemic center.Materials/Methods.A cross-sectional cohort study enrolled NPC patients who were disease-free and ≥4 years post-IMRT ± chemotherapy. Physician-reported adverse events (CTCAE v4.03) and patient-reported QOL (FACT-H&N, FACIT-F), utilities (EuroQOL-5D), head and neck symptoms (MDASI-HN) and emotional distress (HADS), were collected. Consenting patients also underwent endocrine screening and audiometry.ResultsAmong 107 patients enrolled, median age at enrollment and time since treatment were 57 (32-81) and 7.5 years (4.2-11.1) respectively. Most patients (99%) received 70Gy/35#; the majority (93%) received concurrent chemotherapy. Mean scores for the FACT-H&N, FACIT-F, and EQ-5D were 105.0 (46-148), 116.6 (44-160), and 0.85 (0.29-1.00) respectively. Dry mouth, mucus, swallowing/chewing, memory and teeth/gum problems scored highest on the MDASI-HN; mean symptom severity and symptom interference scores were 2.3 and 2.4, respectively. Grade 3 or higher physician-reported adverse events were noted in 50 patients (47%); most frequently hearing (46, 43%). Audiometry revealed significant bilateral hearing loss (≥Grade 3) in 68 patients (72%). Depression (25%), anxiety (37%), and fatigue (28%) were common and strongly correlated with QOL. The majority (69%) of patients developed hypothyroidism; one patient (1%) developed pituitary dysfunction requiring hormone replacement. V50>90 and V45>99 to the thyroid correlated with significantly higher rates of hypothyroidism.ConclusionsDespite the implementation of IMRT, NPC survivors still experience many physical symptoms which impact long-term QOL many years after treatment. Depression, anxiety and fatigue remain common in long-term survivors and are highly correlated with QOL.



https://ift.tt/2JrHwHy