Quality of Life in Locally Advanced Head and Neck Cancer Patients with Different Radiotherapy Techniques after Definitive Chemo Radiotherapy - A Real-World Data Study with Indian Patients

BACKGROUND The standard of care in non-resectable locally advanced head and neck cancer with squamous cell histology is radical radiotherapy (RT) along with concurrent chemotherapy. Previously, these patients were treated with conventional radiotherapy techniques. Such conventional techniques can lead to morbidity with an impact on quality-of-life (QOL) in long-term survivors. Conformal radiotherapy experiences significant improvements in QOL domains versus conventional techniques. Radiotherapy planning and treatment with conformal techniques require advanced and relatively expensive equipment. Our study is aimed at evaluating the feasibility of conventional radiotherapy techniques in terms of quality of life in locally advanced head and neck cancer patients in comparison to the conformal technique in the Indian setting. METHODS Sixty patients with locally advanced head and neck cancer who received chemo-radiation therapy and came for follow-up after a minimum of two years were scheduled to complete the QOL questionnaire (QLQ-C30 and QLQ-H&N35 scores). These scores were compared between the patients who were treated with conventional and conformal techniques. RESULTS Results showed that when comparing EORTC QLQ–C30 scoring, patients who were treated with conventional RT had a significantly higher median score for emotional QOL and lower median scores for fatigue, pain, appetite loss, and financial difficulties as compared to the conformal RT group. But only the financial difficulties scale showed a significant p-value. When comparing EORTC QLQ–H&N35 scores, all QLQ-HN35 scores did not show any significant difference, except for speech problems. Patients treated with the conventional technique had a significantly lower median score for speech problems compared to the conformal RT group. CONCLUSIONS Based on these results, it is concluded that conventional radiotherapy techniques can be advised to locally advanced head and neck cancer patients when conformal radiotherapy techniques are not available, especially in developing or underdeveloped countries.