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 chi(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.