TY - JOUR
T1 - Comparing adaptive and dose redistributed radiotherapy to conventional radiotherapy in head and neck cancer - Quality of life results from the phase III ARTFORCE trial
AU - de Leeuw, Anna Liza M P
AU - Hoebers, Frank J P
AU - Giralt, Md Jordi
AU - Tao, Yungan
AU - Terhaard, Chris H J
AU - Lee, Lip Wai
AU - Friesland, Signe
AU - Steenbakkers, Roel J H M
AU - Tans, Lisa
AU - Kayembe, Mutamba T
AU - van Kranen, Simon R
AU - Bartelink, Harry
AU - Rasch, Coen R N
AU - Sonke, Jan-Jakob
AU - Hamming-Vrieze, Olga
N1 - Publisher Copyright:
© 2025
PY - 2025/9
Y1 - 2025/9
N2 - PURPOSE: This study compared patient-reported quality of life (QoL) between patients with head and neck cancer treated with either FDG/PET-guided dose redistribution with scheduled treatment adaptation (rRT) or conventional radiotherapy (cRT).METHODS: QoL outcomes were assessed at baseline, directly after radiotherapy and at 6-month, 1-, 2-, and 5-year follow up using the EORTC QLQ C30, EORTC QLQ HN35 and EQ-5D-5L. Linear mixed-effects models (LMMs) were used for longitudinal analysis including fixed effects for baseline QoL scores, trial arm, time, an interaction term between trial arm and time and random effects for patients.RESULTS: 142 out of 221 patients (64 %) filled out at least one QoL questionnaire and were included for analysis. QoL was overall comparable between trial arms, with exception of a significant increase in sticky saliva complaints at 1 year and decreased global health status at 2 years in cRT compared to rRT. In the majority of the other LMMs, patients' QoL was significantly associated with their baseline QoL values and initial QoL deterioration observed after treatment was followed by improvement throughout follow up.CONCLUSIONS: In line with the primary results of the trial (ARTFORCE, NCT01504815), dose redistribution combined with scheduled treatment adaptation showed comparable QoL outcome to conventional radiotherapy. Overall, QoL was mostly determined by patients' individual baseline QoL and improved at 6 months of follow up. These results confirm that this dose redistribution strategy is a safe strategy to increase dose to tumor subregions.
AB - PURPOSE: This study compared patient-reported quality of life (QoL) between patients with head and neck cancer treated with either FDG/PET-guided dose redistribution with scheduled treatment adaptation (rRT) or conventional radiotherapy (cRT).METHODS: QoL outcomes were assessed at baseline, directly after radiotherapy and at 6-month, 1-, 2-, and 5-year follow up using the EORTC QLQ C30, EORTC QLQ HN35 and EQ-5D-5L. Linear mixed-effects models (LMMs) were used for longitudinal analysis including fixed effects for baseline QoL scores, trial arm, time, an interaction term between trial arm and time and random effects for patients.RESULTS: 142 out of 221 patients (64 %) filled out at least one QoL questionnaire and were included for analysis. QoL was overall comparable between trial arms, with exception of a significant increase in sticky saliva complaints at 1 year and decreased global health status at 2 years in cRT compared to rRT. In the majority of the other LMMs, patients' QoL was significantly associated with their baseline QoL values and initial QoL deterioration observed after treatment was followed by improvement throughout follow up.CONCLUSIONS: In line with the primary results of the trial (ARTFORCE, NCT01504815), dose redistribution combined with scheduled treatment adaptation showed comparable QoL outcome to conventional radiotherapy. Overall, QoL was mostly determined by patients' individual baseline QoL and improved at 6 months of follow up. These results confirm that this dose redistribution strategy is a safe strategy to increase dose to tumor subregions.
KW - Adaptive radiotherapy
KW - Dose painting
KW - Head and neck cancer
KW - PET
KW - Quality of life
KW - Radiotherapy
UR - https://www.scopus.com/pages/publications/105010310468
U2 - 10.1016/j.radonc.2025.111044
DO - 10.1016/j.radonc.2025.111044
M3 - Article
C2 - 40651596
SN - 0167-8140
VL - 210
JO - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
JF - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
M1 - 111044
ER -