Long-Term Late Toxicity, Quality of Life, and Emotional Distress in Patients With Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy
Long-Term Late Toxicity, Quality of Life, and Emotional Distress in Patients With Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy
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DOI：
10.1016/j.ijrobp.2018.05.060
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发表时间：
2018-10-01
影响因子：
7
通讯作者：
Ringash, Jolie
中科院分区：
文献类型：
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作者：
McDowell, Lachlan J.;Rock, Kathy;Ringash, Jolie
目的：报告在非流行中心接受调强放射治疗 (IMRT) 的鼻咽癌 (NPC) 患者的长期（> 4 年）毒性和生活质量 (QoL)。 方法和材料：一项横断面队列研究纳入了 IMRT +/- 化疗后 4 年以上无病的 NPC 患者。医生报告的不良事件（不良事件通用术语标准，版本 4.03）和患者报告的 QoL（癌症治疗功能评估 - 头颈、慢性疾病治疗功能评估 - 疲劳）、实用性 (Euro-QOL-5D)、头颈症状 (MD 安德森症状清单 - 头颈) 和情绪困扰 (医院收集焦虑和抑郁量表。同意的患者还接受了内分泌筛查和听力测定。结果：在 107 名入组患者中，入组时的中位年龄和治疗后时间分别为 57 岁 (32-81) 和 7.5 岁 (4.2-11.1)。大多数患者 (99%) 分 35 次接受 70 Gy 的照射；大多数（93%）接受同步化疗。癌症治疗功能评估（头颈）、慢性病治疗功能评估（疲劳）和 EuroQOL-5D 的平均得分分别为 105.0 (46-148)、116.6 (44-160) 和 0.85 (0.29-1.00)。口干、粘液、吞咽/咀嚼、记忆力和牙齿/牙龈问题在 MD 安德森头颈症状调查中得分最高；平均症状严重程度和症状干扰评分分别为 2.3 和 2.4。 50 名患者 (47%) 出现了医生报告的 3 级或更高级别的不良事件，其中最常见的是听力问题 (46, 43%)。听力测试显示 68 名患者 (72%) 有显着的双侧听力损失（≥ 3 级）。抑郁（25%）、焦虑（37%）和疲劳（28%）很常见，并且与生活质量密切相关。大多数患者（69%）出现甲状腺功能减退症； 1 名患者 (1%) 出现垂体功能障碍，需要激素替代治疗。甲状腺 V50 > 90 和 V45 > 99 与甲状腺功能减退症发生率显着升高相关。结论：尽管实施了 IMRT，鼻咽癌幸存者在治疗多年后仍然会出现许多影响长期生活质量的身体症状。抑郁、焦虑和疲劳在长期幸存者中仍然很常见，并且与生活质量高度相关。皇冠版权所有 (C) 2018 由爱思唯尔公司出版。保留所有权利。
Purpose: To report long-term (> 4 years) toxicity and quality of life (QoL) among patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT) in a nonendemic center.Methods and Materials: A cross-sectional cohort study enrolled patients with NPC who were disease-free and >= 4 years after IMRT +/- chemotherapy. Physician-reported adverse events (Common Terminology Criteria for Adverse Events, version 4.03) and patient-reported QoL (Functional Assessment of Cancer Therapy-Head and Neck, Functional Assessment of Chronic Illness Therapy-Fatigue), utilities (Euro-QOL-5D), head and neck symptoms (MD Anderson Symptom Inventory-Head and Neck), and emotional distress (Hospital Anxiety and Depression Scale) were collected. Consenting patients also underwent endocrine screening and audiometry.Results: Among 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 70 Gy in 35 fractions; the majority (93%) received concurrent chemotherapy. Mean scores for the Functional Assessment of Cancer Therapy-Head and Neck, Functional Assessment of Chronic Illness Therapy-Fatigue, and EuroQOL-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 were scored highest on the MD Anderson Symptom Inventory-Head and Neck; 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 problems (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. Most patients (69%) developed hypothyroidism; 1 patient (1%) developed pituitary dysfunction requiring hormone replacement. V50 > 90 and V45 > 99 to the thyroid correlated with significantly higher rates of hypothyroidism.Conclusions: Despite the implementation of IMRT, survivors of NPC still experience many physical symptoms that affect long-term QoL many years after treatment. Depression, anxiety, and fatigue remain common in long-term survivors and are highly correlated with QoL. Crown Copyright (C) 2018 Published by Elsevier Inc. All rights reserved.