AUTHOR=Thomas Joel , Wang Hong , Clump David A. , Ferris Robert L. , Duvvuri Umamaheswar , Ohr James , Heron Dwight E. 

TITLE=Long-Term Patient-Reported Quality of Life After Stereotactic Body Radiation Therapy for Recurrent, Previously-Irradiated Head and Neck Cancer

JOURNAL=Frontiers in Oncology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00083

DOI=10.3389/fonc.2020.00083

ISSN=2234-943X

ABSTRACT=<p><bold>Objectives:</bold> Long-term quality-of-life data following stereotactic body radiation therapy (SBRT) for recurrent head and neck cancer (rHNC) is underreported. We report patient-reported quality-of-life (PR-QOL) after at least 1 year post-treatment.</p><p><bold>Methods and Materials:</bold> A retrospective review was performed on 64 patients receiving SBRT for previously-irradiated rHNC. PR-QOL was prospectively evaluated using the University of Washington Quality of Life Questionnaire. The mixed effects proportional odds model was used to assess post-treatment overall PR-QOL changes, as well as the effects of late toxicities, tumor volume &gt; 25 cc, local failure, nodal recurrence, distant failure, prior neck dissection, performance status other than ECOG 0 or Karnofsky 100, sex, age &gt;65, squamous vs. non-squamous primary histology, and specific organ recurrence.</p><p><bold>Results:</bold> SBRT had no significant effect on overall PR-QOL at days 1-90 post-treatment (SBRT effect 0.035, <italic>p</italic> = 0.93) and days 91–365 (SBRT effect −0.30, <italic>p</italic> = 0.45). Beyond day 365, overall PR-QOL was significantly worse than baseline (SBRT effect −0.77, p =.03). Grade ≥3 late toxicities (<italic>p</italic> = 0.0072) and tumor volume &gt; 25 cc (<italic>p</italic> = 0.032) predicted significantly worse overall PR-QOL. Oral cavity recurrence predicted significant decrements in chewing (<italic>p</italic> = 0.0006), swallowing (<italic>p</italic> = 0.0301), and taste PR-QOL (<italic>p</italic> = 0.02). Nasal recurrence predicted significant decrements in taste PR-QOL (<italic>p</italic> = 0.030). Grade ≥3 late dysphagia predicted significant decline in chewing (<italic>p</italic> = 0.039) and swallowing (<italic>p</italic> = 0.0004). Grade ≥3 late osteonecrosis predicted significant differences in pain PR-QOL (<italic>p</italic> = 0.0026).</p><p><bold>Conclusion:</bold> PR-QOL across several domains declines immediately after SBRT for previously-irradiated rHNC before returning to baseline levels at 1 year. Long-term PR-QOL declines thereafter. Patients with grade ≥3 late toxicities or tumor volume &gt;25 cc report reduced long-term overall PR-QOL, likely representing late disease progression. Specific organ recurrence and grade ≥3 late toxicities predict decrements in specific PR-QOL domains.</p>