Quality of life for head and neck cancer patients treated by combined modality therapy: The therapeutic benefit of technological advances in radiotherapy

Purpose: To evaluate quality of life (QoL) in patients with head and neck squamous cell carcinoma (HNSCC) treated by combined modality therapy, with a focus on the therapeutic benefits of QoL that result from technological advances in radiotherapy (RT). Methods: A cross-sectional survey of QoL using the EORTC QLQ-C30 and QLQ-H&N35 questionnaires was performed for 307 HNSCC survivors. One hundred and thirty-five patients were treated by two-dimensional RT (2DRT), 90 by three-dimensional conformal RT (3DCRT), and 82 by intensity-modulated RT (IMRT). The effect size between groups was calculated using Cohen's D coefficient. Results: Those who had a higher annual family income or were treated by more advanced RT techniques had better QoL outcomes. Compared with 2DRT, the impact of 3DCRT was small (Cohen's D: 0.02-0.40) on all QoL scales. For IMRT, the impact was small on most scales and moderate (Cohen's D: 0.55-0.60) on opening mouth, dry mouth, and sticky saliva. Compared with 3DCRT, the impact of IMRT was small (Cohen's D: 0.03-0.29) on all scales. Conclusion: Advances in RT provided a positive effect on QoL outcome, especially on swallowing-related QoL scales, for patients with HNSCC treated by combined modality therapy.