Health-related quality of life changes in nasopharyngeal cancer patients: A propensity score-matched comparison of intensity-modulated proton therapy and volumetric-modulated arc therapy

Background Despite the dosimetric advantages of intensity-modulated proton therapy (IMPT) in treating patients with nasopharyngeal carcinoma (NPC), it remains unclear whether these advantages confer improved health-related quality of life (HRQoL) compared to state-of-the-art photon-based techniques such as volumetric-modulated arc therapy (VMAT). Patients and Methods Patients with NPC eligible for definitive radiation therapy (RT) were invited to participate in the longitudinal observational study. Patient-reported outcomes were assessed using the Functional Assessment of Cancer Therapy - Head & Neck Cancer (FACT-HN) questionnaire at multiple time points: before, during, and after treatment. Propensity score matching (PSM) was utilized to align the IMPT group with the VMAT group. Longitudinal changes in HRQoL were then analyzed using generalized estimating equations (GEEs). Results From 2008 to 2021, a total of 353 patients were enrolled in the study. After applying PSM at a 1:3 ratio, the final analysis included 213 patients in the VMAT group and 71 patients in the IMPT group. There were no significant differences were noted in the mean changes of FACT-HN scores from baseline between the IMPT and VMAT groups during treatment or throughout the follow-up periods as follows (IMPT vs. VMAT): -13.3 vs -14.4 (during RT), 2.2 vs. 1.0 (3 months post-RT), 5.4 vs. 8.5 (6 months post-RT), 10.8 vs. 10.1 (12 months post-RT), 10.2 vs. 10.5 (24 months post-RT), and 13.2 vs. 11.1 (36 months post-RT). Among all the subscales, only the emotional well-being (EWB) subscale demonstrated a significant difference at 36 months, favoring IMPT with scores of 2.7 versus 1.8 (p = 0.026). No significant differences were detected at other time points or within other subscales of interest. Conclusions This study found no clinically significant differences in overall HRQoL, as measured by the FACT-HN questionnaire, between IMPT and VMAT in the treatment of NPC.