Quality of life in patients with oropharynx carcinomas: Assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy
Quality of life in patients with oropharynx carcinomas: Assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy
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DOI：
10.1002/hed.10302
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发表时间：
2003-10-01
影响因子：
2.9
通讯作者：
Dulguerov, P
中科院分区：
文献类型：
--
作者：
Allal, AS;Nicoucar, K;Dulguerov, P
背景。在口咽癌中，不同治疗方法的效果被认为大致相当，而根治性放疗（RT）后的功能结果优于初次手术。本研究的目的是评估两种治疗策略后患者的生活质量 (QoL) 结果：根治性手术加术后 FIT 和加速伴随加强 FIT（加或不加化疗）。方法。研究人员对 60 名口咽癌治疗后至少 1 年无病的患者进行了研究。 40 例接受根治性 FIT 治疗（中位肿瘤剂量，5.5 周内 69.9 Gy），20 例接受初次手术和术后单分割 FIT 治疗（中位剂量，60.2 Gy）。其中 7 名患者在 FIT 的同时接受了化疗，1 名患者在 FIT 之前接受了化疗。功能结果通过头颈癌主观表现状态量表 (PSSHN) 和欧洲癌症研究与治疗组织核心生活质量问卷 (EORTC QLQ-C30) 的一般生活质量进行评估。未配对 t 检验用于评估平均值之间的显着差异。结果。通过使用 PSSHN 模块，FIT 组的分数普遍较高，其中言语分量表存在显着差异 (p = .005)，公共分量表中的饮食有显着差异的趋势 (p = .08)，饮食分量表的正常性差异不显着 (p = .25)。当按肿瘤分期进行分析时，T1-2 肿瘤没有观察到显着差异，而对于 T3-4 肿瘤患者，所有三个分量表中都明显存在有利于 FIT 组的高度显着差异。尽管使用 EORTC QLQ C-30 功能量表未观察到显着差异，但接受初次手术治疗的患者报告呼吸困难（28 vs 12，p = .04）和食欲下降（30 vs 13，p = .05）显着增加。在 T3-4 肿瘤患者中，观察到 FIT 组在身体、角色、情绪和社会功能方面的评分有利于 FIT 组的趋势，并且疼痛症状的评分也显着提高。结论。尽管在早期阶段，与手术组相比，FIT 组的生活质量结果没有明显优势，但对于晚期疾病，根治性放疗的优势似乎很明显。对于这些患者，如果在肿瘤学结果方面可以假设两种治疗策略之间是等效的，那么非手术治疗应被视为首选选择。 (C) 2003 年 Wiley 期刊公司。
Background. In oropharyngeal carcinomas, it is assumed that the effectiveness of the different treatment approaches is roughly equivalent, whereas the functional outcome after radical radiotherapy (RT) is superior to that associated with primary surgery. The aim of this study is to assess quality of life (QoL) outcomes of patients after two treatment strategies: radical surgery with postoperative FIT and accelerated concomitant boost FIT with or without chemotherapy.Methods. Sixty patients who were disease free at least 1 year after treatment of oropharynx carcinoma were studied. Forty had been treated with radical FIT (median tumor dose, 69.9 Gy in 5.5 weeks), and 20 had been treated with primary surgery and postoperative monofractionated FIT (median dose, 60.2 Gy). Seven of the former patients received chemotherapy concomitantly with, and one before, FIT. Functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and the general QoL by the European Organization for Research and Treatment of Cancer Core QoL questionnaire (EORTC QLQ-C30). The unpaired t test was used to assess for significant differences between means.Results. By use of the PSSHN module, scores were generally higher in the FIT group, with a significant difference in the speech subscale (p = .005), a trend for a significant difference for the eating in public subscale (p = .08), and an insignificant difference for the normalcy of diet subscale (p = .25). When analyzed by tumor stage, no significant differences were observed for T1-2 tumors, whereas for patients with T3-4 tumors highly significant differences favoring the FIT group became evident for all three subscales. Although no significant differences were observed using the EORTC QLQ C-30 functional scales, patients treated with primary surgery reported significantly more dyspnea (28 vs 12, p = .04) and appetite loss (30 vs 13, p = .05). In patients with T3-4 tumors, trends toward better scores favoring the FIT group were observed for physical, role, emotional, and social functions, as well as a significantly better score for pain symptoms,Conclusions. Although for early stages no clear advantage in QoL outcome was noted for the FIT group compared with the surgery group, for advanced-stage disease an advantage favoring radical RT seemed apparent. For those patients, if an equivalency between the two treatment strategies could be assumed regarding oncologic results, then nonsurgical treatment should be considered the preferred option. (C) 2003 Wiley Periodicals Inc.