The impact of palliative radiotherapy on health-related quality of life in patients with head and neck cancer – Results of a multicenter prospective cohort study

PURPOSE: Palliative radiotherapy for patients with head and neck cancer can be used to alleviate symptoms. Only a few studies have investigated its impact on patient-reported outcomes (PRO). Therefore, we conducted a prospective multicenter observational study. The primary objective was to assess changes in health-related quality of life (HrQoL) per PRO. METHODS: Eligibility criteria included i.) head and neck cancer and ii.) palliative radiotherapy indicated (EQD(2Gy) < 60 Gy). The primary follow-up date was eight weeks after radiotherapy (t(8w)). PRO measures included the EORTC QLQ-C30 and EORTC QLQ-H&N43 and pain per Numeric Rating Scale (NRS). Per protocol, five PRO domains were to be reported in detail as well as PRO domains corresponding to a primary and secondary symptom as determined by the individual patient. We defined a minimal important difference (MID) of 10 points. RESULTS: From 06/2020 to 06/2022, 61 patients were screened and 21 patients were included. Due to death or decline in health-status, HrQoL data was available for 18 patients at the first fraction and for eight patients at t(8w). The MID was not met for the predefined domains in terms of mean values as compared from first fraction to t(8w). Individually in those patients with available HrQoL data at t(8w), 71% (5/7) improved in their primary and 40% (2/5) in their secondary symptom domain reaching the MID from first fraction to t(8w), respectively. There was a significant improvement in pain per NRS in those patients with available data at t(8w) per Wilcoxon signed rank test (p = 0.041). Acute mucositis of grade ≥3 per CTCAE v5.0 occurred in 44% (8/18) of the patients. The median overall survival was 11 months. CONCLUSION: Despite low patient numbers and risk of selection bias, our study shows some evidence of a benefit from palliative radiotherapy for head and neck cancer as measured by PRO. German Clinical Trial Registry identifier: DRKS00021197.