Health-Related Quality of Life Outcomes in Head and Neck Cancer: Results From a Prospective, Real-World Data Study With Brazilian Patients Treated With Intensity Modulated Radiation Therapy, Conformal and Conventional Radiation Techniques

Development, Validation, and Valuation of a Head and Neck Cancer-Specific Health Utility Instrument (HNC-8D): A Head and Neck Cancer International Group Collaborative Study

Importance

Generic health utility instruments lack the discriminative ability to differentiate among health states in patients after head and neck cancer treatment.

Objective

To develop, validate, and valuate a head and neck cancer-specific health utility measure.

Design, Setting, and Participants

This psychometric study comprised 2 phases to develop and validate a health utility instrument. The first phase, development and validation, occurred from January 2021 to August 2022. An expert panel selected disease-specific quality-of-life instruments as the basis for a new utility instrument. Two datasets (n = 458 and 493) were used to establish dimension structure through exploratory factor analysis, and to select items using Rasch and psychometric criteria and expert opinion. Discriminative validity of the new instrument was tested by comparing scores for different disease severities (patients with and without gastrostomy and tracheostomy tubes). The second phase, valuation, was conducted from January 2023 to January 2024 in a quaternary referral center with healthy participants. Participants completed time-trade-off exercises for 100 sampled health states and were randomized to discovery and validation sets (80:20). Using a repeated measures model, a scoring algorithm to predict utilities of health states within the instrument was created in the discovery set and tested in both sets. Data were analyzed from January 2022 to December 2023.

Intervention

Participants performed time-trade-off exercises for various states.

Main Outcomes and Measures

Discriminative validity (first phase) and the mean absolute differences of predicted and observed utilities (second phase).

Results

The European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire-Core 30 and its Head and Neck module 43 were selected by the expert panel and used as the basis instruments. Exploratory factor analysis established 8 dimensions, with 1 item selected per dimension. Of the 488 respondents, 84 with gastrostomy and/or tracheostomy tubes reported lower scores for 7 of the 8 items. In the second phase, 2497 valuations were performed by 250 healthy participants (mean [SD] age, 42.4 [16.5] years; 166 [66%] females). The scoring algorithm produced mean absolute differences between predicted and observed utilities of 0.041 (95% CI, 0.034-0.047) and 0.082 (95% CI, 0.065-0.100) in the discovery and validation sets, respectively.

Conclusions and Relevance

This psychometric study developed a new head and neck cancer-specific utility measure, the HNC-8D (Head and Neck Cancer-8 Dimensions). The instrument demonstrated predictive accuracy for measuring health utility and can be used to differentiate health utility states following head and neck cancer treatment.

A prospective study to assess and quantify the setup errors with cone-beam computed tomography in head-and-neck cancer image-guided radiotherapy treatment

Introduction

This study was done to quantify the translational setup errors with cone-beam computed tomography (CBCT) in the image-guided radiation therapy (IGRT) treatment of head-and-neck cancer (HNC) patients.

Aims

The objective was to quantify the setup errors by CBCT.

Methodology

One hundred patients of HNC were enrolled from March 2020 to March 2021 for IGRT treatment. Pretreatment kV-CBCT images were obtained at the first 3 days of irradiations, and setup error corrections were done in the mediolateral (ML), superior-inferior (SI), and anterior-posterior (AP) directions. Subsequently, a weekly kV-CBCT was repeated for whole duration of radiotherapy for the next 6-7 weeks. Adequacy of planning target volume (PTV) margins was assessed by van Herk's formula.

Results

Total 630 CBCT scans of 100 patients were analyzed. Setup errors greater than 3 mm and 5 mm were seen in 11.4% and 0.31% of the patients, respectively. Systematic errors and random errors before correction in ML, SI, and AP directions were 0.10 cm, 0.11 cm, and 0.12 cm and 0.24 cm, 0.20 cm, and 0.21 cm, respectively. Systematic errors and random errors after correction in ML, SI, and AP directions were 0.06 cm, 0.07 cm, and 0.07 cm and 0.13 cm, 0.10 cm, and 0.12 cm, respectively.

Conclusion

CBCT at the first 3 fractions and then weekly during radiotherapy is effective to detect the setup errors. An isotropic PTV margin of 5 mm over clinical target volume is safe to account for setup errors, however, in the case of close organ at risk, or with IGRT, a PTV margin of 3 mm can be considered.

Late radiation effects in survivors of head and neck cancer: State of the science

Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.