Quality of life after curative radiotherapy in Stage I non-small-cell lung cancer

Langendijk, Johannes A; Aaronson, Neil K; de Jong, Jos M.A; ten Velde, Guul P.M; Muller, Martin J; Slotman, Ben J; Wouters, Emiel F.M

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Volume 53, Issue 4 , Pages 847-853, 15 July 2002

Quality of life after curative radiotherapy in Stage I non-small-cell lung cancer

Johannes A Langendijk, M.D., Ph.D.
- Reprint requests to: J.A. Langendijk, M.D., Department of Radiation Oncology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Tel: +31-20-4440413; Fax: +31-20-4440410
- Radiotherapeutisch Instituut Limburg, Heerlen, The Netherlands
Neil K Aaronson, M.D., Ph.D.
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Jos M.A de Jong, M.D., Ph.D.
- Radiotherapeutisch Instituut Limburg, Heerlen, The Netherlands
Guul P.M ten Velde, M.D., Ph.D.
- Department of Respiratory Diseases, University Hospital Maastricht, Maastricht, The Netherlands
Martin J Muller
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Ben J Slotman, M.D., Ph.D.
- Department of Radiation Oncology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
Emiel F.M Wouters, M.D., Ph.D.
- Department of Respiratory Diseases, University Hospital Maastricht, Maastricht, The Netherlands

Received 5 December 2001; received in revised form 11 March 2002; accepted 19 March 2002.

Abstract

The aim of this study was to investigate changes in quality of life (QOL) among medically inoperable Stage I non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy.

The study sample was composed of 46 patients irradiated for Stage I NSCLC. Quality of life was assessed before, during, and after radiotherapy using the European Organization for the Research and Treatment of Cancer QLQ-C30 and QLQ-LC13. Changes in symptom and QOL scores over time were evaluated with a repeated measurement analysis of variance using the mixed effect modeling procedure, SAS Proc Mixed. Twenty-seven patients were treated only at the primary site, whereas for 19 patients, the regional lymph nodes were included in the target volume as well.

The median follow-up time of patients alive was 34 months. The median survival was 19.0 months. None of the locally treated patients developed regional recurrence. A significant, gradual increase over time was observed for dyspnea, fatigue, and appetite loss. A significant, gradual deterioration was observed also for role functioning. No significant changes were noted for the other symptoms or the functioning scales. Significantly higher levels of dysphagia, which persisted up to 12 months, were observed in those in which the regional lymph nodes were treated, as compared to the locally treated patients. Radiation-induced pulmonary changes assessed with chest radiograph were more pronounced in the group treated with locoregional radiotherapy.

After curative radiotherapy for Stage I medically inoperable NSCLC, a gradual increase in dyspnea, fatigue, and appetite loss, together with a significant deterioration of role functioning, was observed, possibly because of pre-existing, slowly progressive chronic obstructive pulmonary disease and radiation-induced pulmonary changes. Taking into account the low incidence of regional recurrences after local irradiation, the higher incidence and severity of radiation-induced changes, and the higher levels of dysphagia persisting up to 12 months, local irradiation of the primary tumor without elective irradiation of the regional lymph nodes may be the most appropriate treatment for patients with small, peripherally located tumors.