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Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

Slide: 28 of 36

Studies Regarding Quality of Life and Adverse Events: IMRT vs. 3DCRT

Consistent results favoring IMRT over 3DCRT were observed for late xerostomia and quality-of-life domains related to xerostomia. Adverse event comparisons that reported numerical differences in incidence of late xerostomia (≥ grade 2) are presented graphically in this slide. Four studies found large (greater than 15 percentage points) significant differences favoring IMRT over 3DCRT in the frequency of late xerostomia. The results of one unpublished, randomized, controlled trial, presented at the 2009 annual meeting of the American Society of Clinical Oncology, showed a large advantage for IMRT in the frequency of late xerostomia of grade 2 or higher (risk difference, 35 percentage points; 95% CI, 12.6–55.5). Six observational studies that reported late xerostomia all favored IMRT. Of the five studies that reported frequencies, the reported range of differences was 7 to 79 percentage points. Data not shown:

• Quality of life was reported in three observational studies and generally favored IMRT. Significant advantages for IMRT included these domains: dry mouth, sticky saliva, taste/smell, fatigue, and feeling ill.

• Acute xerostomia, acute mucositis, late mucositis, acute dysphagia, late skin toxicity, and late osteoradionecrosis and bone toxicity were reported in some and typically favored IMRT, but differences were not consistently statistically significant. Among studies of acute skin toxicity, neither the size of the difference nor the direction was consistent.