Health related quality of life in head and neck cancer treated with radiation therapy with or without chemotherapy: A systematic review

Health-related quality of life (HRQoL) is a subjective measure of patients' experience of disease and treatment. We systematically reviewed the literature to identify high quality manuscripts reporting HRQoL outcomes in adults with squamous cell carcinoma of the head and neck (HNSCC) treated with an organ-sparing curative regimen of radiation therapy with or without chemotherapy. Assessments were performed independently by two reviewers; a third reviewer resolved disputes. High quality reports were reviewed in detail to identify trends in HRQoL outcomes. MEDLINE and EMBASE searching yielded 276 distinct reports, plus 24 added via hand search. Of these, 53 met eligibility criteria and 18 were deemed high quality reports on the basis of a quality assessment tool. HRQoL declines after treatment but recovers to baseline levels, generally within 12 months. However, xerostomia-related HRQoL deficits may remain long-term. Combined chemoradiotherapy showed a trend toward worse HRQoL compared with RT alone. Intensity modulated radiotherapy (IMRT) yields better HRQoL compared with conventional or three-dimensional conformal radiotherapy. Baseline HRQoL may independently predict local-regional control and overall survival. Future research should incorporate HRQoL into phase III trials. However, adequate effort and journal space must be afforded to the HRQoL results of these studies to ensure proper reporting methods are followed, allowing clinicians to incorporate HRQoL into patient counseling and clinical decision making.