Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: Quality of life in a prospective phase I/II trial

Background and purposeQuality of life (QOL) was measured prospectively in a dose escalation study of twice daily hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer (HNC).Materials and methodsPatients with squamous cell HNC (TNM stage III/IV larynx or pharynx, or hypopharynx any stage) received 40 fractions of twice daily RT at 3 dose levels: (L1) 60 Gy, 1.5 Gy/fraction; (L2) 62 Gy, 1.55 Gy/fraction; and (L3) 64 Gy, 1.6 Gy/fraction. QOL was measured on the FACT-H&N at baseline, 6 and 12 months.ResultsMean QOL scores were: baseline 104, 6 months 108, 12 months 112. At all time points, QOL scores were lower in patients with more advanced T-category. A mixed-model analysis of determinants of QOL showed no dose effect among L1 (n = 22), L2 (n = 26) or L3 (n = 123). QOL improved significantly with time from diagnosis, however post-treatment QOL was lower and improved more slowly in patients who had feeding tubes.ConclusionsPost-RT QOL improved from baseline by a statistically and clinically significant amount. Hyperfractionated, accelerated RT provides favorable QOL outcomes, and is a viable alternative to chemoradiation for patients with locally advanced HNC.