Quality of life in patients with oropharynx carcinomas: Assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy

Background. In oropharyngeal carcinomas, it is assumed that the effectiveness of the different treatment approaches is roughly equivalent, whereas the functional outcome after radical radiotherapy (RT) is superior to that associated with primary surgery. The aim of this study is to assess quality of life (QoL) outcomes of patients after two treatment strategies: radical surgery with postoperative FIT and accelerated concomitant boost FIT with or without chemotherapy. Methods. Sixty patients who were disease free at least 1 year after treatment of oropharynx carcinoma were studied. Forty had been treated with radical FIT (median tumor dose, 69.9 Gy in 5.5 weeks), and 20 had been treated with primary surgery and postoperative monofractionated FIT (median dose, 60.2 Gy). Seven of the former patients received chemotherapy concomitantly with, and one before, FIT. Functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and the general QoL by the European Organization for Research and Treatment of Cancer Core QoL questionnaire (EORTC QLQ-C30). The unpaired t test was used to assess for significant differences between means. Results. By use of the PSSHN module, scores were generally higher in the FIT group, with a significant difference in the speech subscale (p = .005), a trend for a significant difference for the eating in public subscale (p = .08), and an insignificant difference for the normalcy of diet subscale (p = .25). When analyzed by tumor stage, no significant differences were observed for T1-2 tumors, whereas for patients with T3-4 tumors highly significant differences favoring the FIT group became evident for all three subscales. Although no significant differences were observed using the EORTC QLQ C-30 functional scales, patients treated with primary surgery reported significantly more dyspnea (28 vs 12, p = .04) and appetite loss (30 vs 13, p = .05). In patients with T3-4 tumors, trends toward better scores favoring the FIT group were observed for physical, role, emotional, and social functions, as well as a significantly better score for pain symptoms, Conclusions. Although for early stages no clear advantage in QoL outcome was noted for the FIT group compared with the surgery group, for advanced-stage disease an advantage favoring radical RT seemed apparent. For those patients, if an equivalency between the two treatment strategies could be assumed regarding oncologic results, then nonsurgical treatment should be considered the preferred option. (C) 2003 Wiley Periodicals Inc.