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Impact of Late Treatment-Related Toxicity on Quality of Life Among Patients With Head and Neck Cancer Treated With Radiotherapy

Johannes A. Langendijk, Patricia Doornaert, Irma M. Verdonck-de Leeuw, Charles R. Leemans, Neil K. Aaronson, Ben J. Slotman

From the Departments of Radiation Oncology and Otolaryngology/Head and Neck Surgery, VU University Medical Center; Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam; and Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands

Corresponding author: Johannes A. Langendijk, MD, PhD, Department of Radiation Oncology, University Medical Center Groningen, PO Box 30001, 9300 RB Groningen, the Netherlands; e-mail: j.a.langendijk{at}rt.umcg.nl

Purpose To investigate the impact of treatment-related toxicity on health-related quality of life (HRQoL) among patients with head and neck squamous cell carcinoma treated with radiotherapy either alone or in combination with chemotherapy or surgery.

Patients and Methods The study sample was composed of 425 disease-free patients. Toxicity was scored according to the European Organisation for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) late radiation-induced morbidity scoring system. HRQoL was assessed using the EORTC Quality of Life Questionnaire C30. These assessments took place at 6, 12, 18, and 24 months after completion of radiotherapy. The analysis was performed using a multivariate analysis of variance.

Results Of the six RTOG scales investigated, two significantly affected self-reported HRQoL, salivary gland (RTOG_xerostomia) and esophagus/pharynx (RTOG_swallowing). Although RTOG_xerostomia was reported most frequently, HRQoL was most affected by RTOG_swallowing, particularly in the first 18 months after completion of radiotherapy.

Conclusion Late radiation-induced toxicity, particularly RTOG_swallowing and RTOG_xerostomia, has a significant impact on the more general dimensions of HRQoL. These findings suggest that the development of new radiation-induced delivery techniques should not only focus on reduction of the dose to the salivary glands, but also on anatomic structures that are involved in swallowing.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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