Patient Reported Outcomes/Quality of Life

PV QA 4 - Poster Viewing Q&A 4

TU_41_3721 - A Prospective Evaluation of Health-Related Quality of Life Outcomes After Skull Base Re-Irradiation

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

A Prospective Evaluation of Health-Related Quality of Life Outcomes After Skull Base Re-Irradiation
H. Bahig, S. P. Ng, C. Pollard III, T. Nguyen, G. B. Gunn, D. I. Rosenthal, C. D. Fuller, S. J. Frank, A. S. Garden, J. Reddy, W. H. Morrison, E. Y. Hanna, F. DeMonte, S. Y. Su, and J. Phan; The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Health-related patient reported quality of life outcomes (HR-PRO) after skull base re-irradiation (re-RT) have never previously been reported. The aim of this prospective study was to assess early HR-PRO after highly conformal re-RT to the skull base.

Materials/Methods: Patients with a past history of skull base radiotherapy (RT) and dispositioned to receive a course of re-RT to a recurrent or new primary tumor of the skull base were prospectively enrolled. HR-PRO were assessed at baseline, 2 weeks (2W) post-RT, and at 3, 6, 9 and 12 months post-RT using the MD Anderson Symptom Inventory Brain Tumor (MDASI-BT) and the anterior skull base surgery QoL (ASBQ) questionnaires. MDASI-BT scores ranged from 0 to 10, with higher score indicating worse outcome, while ASBQ scores ranged from 0 to 5, with lower scores indicating worse outcome. HR-PRO were analyzed using linear mixed models, with p<0.05 considered statistically significant. As per previous work, MDASI-BT score difference of ≥1 was considered clinically significant. Kaplan Meier analysis was used for secondary outcomes of local control (LC), progression free survival (PFS) and overall survival (OS).

Results: Forty-nine patients with a median age of 60 year-old (range= 33-85) were enrolled. Median interval between past RT and re-RT was 2 years (range = 1- 47 years). Most common primary sites were paranasal sinuses (41%), parotid gland (22%), and nasopharynx/retropharynx (20%). Fifty-one percent of patients were treated with conventionally fractionated intensity modulated radiotherapy or proton therapy to a median dose of 62 Gy (range= 40-70) in 30 fractions (range= 20-33) while 39% were treated with stereotactic body radiotherapy (SBRT) to a median dose of 45 Gy (16-45) in 5 fractions (range= 1-5). Thirty-five percent of patients had surgery before re-RT, while 29% and 51% had induction and concurrent chemotherapy, respectively. Median follow-up was 11 months. Actuarial LC, PFS and OS at 1 year were 81%, 60% and 89%, respectively. At 2W post-RT, MDASI-BT score showed mild worsening of fatigue (baseline mean score = 3 vs. 2W post-RT mean score = 4, p=0.03) and appetite loss (1.8 vs. 2.7, p=0.008). There was a worsening of ASBQ score 2W post-RT compared to baseline for the physical function domain (3.8 vs. 3.4, p=0.04) and specific symptoms domain (3.9 vs. 3.5, p=0.04); these scores returned to baseline for all subsequent time points. There was no deterioration of other HR-PRO scores. ASBQ emotional domain showed improvement at 3 months compared to baseline (3.5 vs. 3.8 p=0.015), which was maintained on subsequent time points. There were no differences in HR-PRO scores between conventionally fractionated and SBRT re-RT.

Conclusion: Skull base re-RT is associated with mild, immediate post-RT deterioration in fatigue and appetite loss (MDASI-BT) as well as physical function and specific symptoms (ASBQ), which returned to baseline at 3-months post-RT. This study shows overall excellent tolerance of patients to highly conformal skull base re-RT.

Author Disclosure: H. Bahig: Research Grant; Varian Medical systems. Honoraria; Siemens. S. Ng: Employee; The University of Texas MD Anderson Cancer Center. C. Pollard: None. T. Nguyen: None. G.B. Gunn: Associate Medical Director; MD Anderson Cancer Center - Proton Therapy. D.I. Rosenthal: None. C.D. Fuller: Research Grant; National Institutes of Health, National Science Foundation, Elekta AB. Grant funding; Elekta AB. Honoraria; Nederlandse Organisatie voor Wetenschappelijk Onde. Consultant; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Travel Expenses; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Reviewer; Radiological Society of North America. Associate Editor; Radiographics. Data Management Task Force Committee Member; MR-LinAc Consortium. Member; National Cancer Institute. Task Group Member; American Association of Physicists in Medicine. S.J. Frank: Research Grant; C4 Imaging, ELEKTA, U19. Founder and Director; C4 Imaging. Honoraria; ELEKTA, Varian Medican Systems, Inc. Advisory Board; Varian Medican Systems, Inc. Stock; C4 Imaging. Royalty; C4 Imaging. Patent/License Fees/Copyright; C4 Imaging. Chairman; American Brachytherapy Society. Director; C4 Imaging. Director-at-large; North America Skull Base Society. A.S. Garden: None. J. Reddy: None. W.H. Morrison: Advisory Board; Regeneron. Stock; Merck, Baxter, Johnson and Johnson. Member; NCCN Nonmelanoma Skin and Merkel Cell Committees. S.Y. Su: None.

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