Concomitant twice-a-day radiotherapy and chemotherapy in unresectable headand neck cancer patients: A long-term quality of life analysis

Background. The purpose of this study is to make a comparative analysis bet ween acute toxicity with late toxicity. This study is based upon a French q uality of life (QoL) questionnaire in a cohort of advanced head and neck (H &N) cancer patients treated by concomitant twice-a-day continuous radiother apy with no acceleration and chemotherapy with cisplatin and 5-fluorouracil . Methods. From September 1992 to November 1997, a prospective data bank of 9 1 patients was constituted, in November 1999, 31 patients were still alive and followed for more than 3 years. All patients had stage IV strictly unre sectable squamous cell carcinoma of oropharynx or hypopharynx. A French spe cific 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 refle ct comparison of percentages obtained at the end of treatment with percenta ges 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. Ac ute treatment toxicities were severe with declines in virtually all QoL and functional domains. Globally, with an average long-term follow-up of 4.5 y ears (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 probl ems (77% versus 36%, p < .05); and H&N pain (86% versus 9%, p < .05). Finan cial problems were not improved (21% versus 14%, not significant), and psyc hological problems (59% versus 5%) were statistically significant. Fourteen of 29 (48%) patients were drinking and 8 of 29 (28%) were smoking at longt erm follow-up; at the diagnosis they were 86% and 90%, respectively. At lon g-term follow-up 22 of 29 presented good or very good QoL, and 25 of 29 sai d they had improved their initial QoL. Conclusion. The interest of twice-a-day radiotherapy with concomitant chemo therapy is to increase total radiotherapy equivalent dose without increasin g late toxicity and also to improve locoregional control, survival, and lon g-term QoL/effectiveness ratio. Best supportive care is recommended to obta in both good QoL and cancer control in a long-term followup. (C) 2001 John Wiley 8 Sons, Inc.