Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial

Pow, Edmond H.N.; Kwong, Dora L.W.; McMillan, Anne S.; Wong, May C.M.; Sham, Jonathan S.T.; Leung, Lucullus H.T.; Leung, W. Keung

doi:10.1016/j.ijrobp.2006.06.013

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Volume 66, Issue 4 , Pages 981-991, 15 November 2006

Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial

Edmond H.N. Pow, M.D.S.
- Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR
Dora L.W. Kwong, M.B. B.S.
- Department of Clinical Oncology, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
Anne S. McMillan, Ph.D.
- Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR
- Reprint requests to: Anne McMillan, Ph.D., Faculty of Dentistry, University of Hong Kong, 34 Hospital Road, Hong Kong SAR. Tel: (+852) 2859-0305; Fax: (+852) 2858-6114
May C.M. Wong, Ph.D.
- Periodontology and Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR
Jonathan S.T. Sham, M.D.
- Department of Clinical Oncology, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
Lucullus H.T. Leung, Ph.D.
- Department of Clinical Oncology, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
W. Keung Leung, Ph.D.
- Periodontology and Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR

Received 2 May 2006; received in revised form 15 June 2006; accepted 15 June 2006.

Purpose: To compare directly the effect of intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) on salivary flow and quality of life (QoL) in patients with early-stage nasopharyngeal carcinoma (NPC).

Methods and Materials: Fifty-one patients with T2, N0/N1, M0 NPC took part in a randomized controlled clinical study and received IMRT or CRT. Stimulated whole (SWS) and parotid (SPS) saliva flow were measured and Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core quetionnaire, and EORTC head-and-neck module (QLQ-H&N35) were completed at baseline and 2, 6, and 12 months after radiotherapy.

Results: Forty-six patients (88%) were in disease remission 12 months after radiotherapy. At 12 months postradiotherapy, 12 (50.0%) and 20 patients (83.3%) in the IMRT group had recovered at least 25% of preradiotherapy SWS and SPS flow respectively, compared with 1 (4.8%) and 2 patients (9.5%), respectively, in the CRT group. Global health scores showed continuous improvement in QoL after both treatments (p < 0.001). However, after 12 months subscale scores for role-physical, bodily pain, and physical function were significantly higher in the IMRT group, indicating a better condition (p < 0.05). Dry mouth and sticky saliva were problems in both groups 2 months after treatment. In the IMRT group, there was consistent improvement over time with xerostomia-related symptoms significantly less common than in the CRT group at 12 months postradiotherapy.

Conclusions: IMRT was significantly better than CRT in terms of parotid sparing and improved QoL for early-stage disease. The findings support the case for assessment of health-related QoL in relation to head-and-neck cancer using a site-specific approach.

Keywords: Nasopharyngeal carcinoma, Radiotherapy, Parotid sparing, Quality of life, Randomized controlled clinical trial