Chin J Radiol 2004; 29: 21-28

Transcription

1 Chin J Radiol 2004; 29: [1-5] [6-8] [9] [10] 86-92

2 EORTC QLQ-C30 global health status 1 7 Likert s physical functioning role functioning emotional functioning cognitive functioning social functioning 40 Gy 18 Gy EORTC QLQ-C International Federation of Gynecology and Obstetrics FIGO IA IB IIA t SPSS 10.0 EORTC QLQ C-30 tumor < 3mm bulky endocervical Barrel-shaped cervix % % 77.0% 23.0% 36.9% 34.6% 8.3% European Organization for Research and Treatment of Cancer, EORTC EORTC QLQ-C30 [1-3] RTOGEORTC 1995 [11] EORTC QLQ-C % % % % % % % 9 4.1% 0 0.0% % %

3 % 4.1% 0.0% 31.3% 68.7% 27.4% 26.4% 23.6% 48.6% 46.8% 40.5% 35.1% 27.9% 26.1% 24.3% 49.1% 45.3% 33.0% 29.2% 46.8%, p < %, p = %, p = %, p = %, p = %, p = n = 217 OP+RT RT X 2 p % % % % % % 7.054** % % *** % % % % % % % % 4.193* % % 8.500** % % % % 4.744* % % % % % 6 5.7% 3.826*.050 * p<0.05, ** p<0.01, *** p<0.001 RT Radiotherapy OP Operation n = 217 OP+RT RT t p * * * * * ** ** *.046 * p<0.05, ** p<0.01, *** p<0.001

4 24 QLQ-C30 EORTC [18] p = p = p = p = p = p = p = p = % vs. 23.6%, p < % vs. 9.4%, p = % vs. 27.4%, p = % vs. 5.7%, p = % vs. 27.9%, p = % vs. 5.4%, p = Barter [19] 30% Fiorica [20] 24% % 4.87% % [9] EORTC QLQ-C30 Montz [21] 23.6%, p < Barnes [22] 46.8% vs. 24.3% vs. 9.4%, p = Magrina [23] 20% 48.6% 46.8% 40.5% 35.1% 49.1% 45.3% 33.0% 15] Jereczek-Fossa [12] 30% Bye [15] [12- Martinbeau [24] 23.4% Werngren-Elgstrom [25] 54 41% 5% 28% 5% 6% 10% 7% 15% 22% [23, 26] 40.5% vs. 27.4%, p = Klee [16] 118 Parkin [17] % Magrina [23] 21% Farquharson [27] 30

5 25 63% 23% 26% macroscopic [10, 15, 17, 19, 24, 37] [28] [29] 13.5% vs. 5.7%, p = Bye [34] Anderson [30] Feeney [31] 40-50% Perez [10] 45.3% vs. 27.9%, p = % vs. 5.4%, p = % vs. 27.9%, p = Crook [32] [33] 0.6% Bye [34] 3-4 Eifel Grigsby [35] Christman [36] % vs. 5.4%, p = EORTC QLQ C-30 t- CH p = p = p = p = p = p = p = Morita [37] microscopic 1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. JNCI 1993; 85: Bjordal K, Ahlner-Elmqvist M, Hammerlid E, et al. A

6 26 prospective study of quality of life in head and neck cancer patients. Part II: longitudinal data. Laryngoscope 2001; 111: Bjordal K, de Graeff A, Fayers PM, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer 2000; 36: Chang VT, Thaler HT, Polyak TA, Kornblith AB, Lepore JM, Portenoy RK. Quality of life and survival. The role of multidimensional symptom assessment. Cancer 1998; 83: Cooper CL. Self transcendence and emotional wellbeing in women with advanced breast cancer. Oncol Nursing Forum 1991; 18: The WHOQOL group. Development of World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998; 28: The WHOQOL group. The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995; 41: The WHOQOL group. The World Health Organization Quality of Life assessment (WHOQOL): Development and general psychometric properties. Soc Sci Med 1998; 46: Perez CA. Uterine cervix. In: Perez CA, Brady LW, editors. Principles and practice of radiation oncology. Third edition. Philadelphia: Lippincott-Raven; 1998: Rubin P, Constine LS, Fajardo LF, et al. RTOG late effects working group. Overview late effects of normal tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 1995; 31: Jereczek-Fossa BA, Marsiglia HR, Orecchia R. Radiotherapy-related fatigue. Crit Rev Oncol Hematol 2002; 41: Barnes EA, Bruera E. Fatigue in patients with advanced cancer: a review. Int J of Gynecol Cancer 2002; 12: Morrow GR, Andrews PL, Hickok JT, Roscoe JA, Matteson S. Fatigue associated with cancer and its treatment. Supportive Care in Cancer 2002; 10: Bye A, Ose T, Kaasa S. Quality of life during pelvic radiotherapy. Acta Obstet Gynecol Scand 1995; 74: Klee M, Thranov I, Machin D. The patients' perspective on physical symptoms after radiotherapy for cervical cancer. Gynecol Oncol 2000; 76: Parkin DE, Davis JA, Symonds RP. Long-term bladder symptomatology following radiotherapy for cervical carcinoma. Radiother Oncol 1987; 9: Parkin DE, Davis JA, Symonds RP. Urodynamic findings following radiotherapy for cervical carcinoma. Br J Urol 1988; 61: Barter JF, Soong SJ, Shingleton HM, et al. Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer. Gynecol Oncol 1989; 32: Fiorica JV, Roberts WS, Greenberg H, et al. Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy. Gynecol Oncol 1990; 36: Montz FJ, Holschneider CH, Solh S, et al. Small bowel obstruction following radical hysterectomy: Risk factors, incidence, and operative findings. Gynecol Oncol 1994; 53: Barnes W, Waggoner S, Delgado G, et al. Manometric characterization of rectal dysfunction following radical hysterectomy. Gynecol Oncol 1991; 42: Magrina JF, Goodrich MA, Weaver AL, et al. Modified radical hysterectomy: Morbidity and mortality. Gynecol Oncol 1995; 59: Martinbeau PW, Kjorstad KE, Kolstad P. Stage IB carcinoma of the cervix, the Norwegian Radium Hospital, : Results of treatment and major complications. I: Lymphedema. Am J Obstet Gynecol 1978; 131: Werngren-Elgstrom M, Lidman D. Lymphoedema of the lower extremities after surgery and radiotherapy for cancer of the cervix. Scand J of Plastic & Reconstructive Surg & Hand Surg 1994; 28: Soisson AP, Soper JT, Clarke-Pearson DL, Berchuck A, Montana G, Creasman WT. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer. Gynecol Oncol 1990; 37: Farquharson DI, Shingleton HM, Soong SJ, Sanford SP, Levy DS, Hatch KD. The adverse effects of cervical cancer treatment on bladder function. Gynecol Oncol 1987; 27: Seski JC, Diokno AC. Bladder dysfunction after radical abdominal hysterectomy. Am J Obstet Gynecol 1997; 128: Zoubek J, McGuire EJ, Noll F, DeLancey JO. The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma. J Urol 1989; 141: Anderson B, LaPolla J, Turner D, et al. Ovarian transposition in cervical cancer. Gynecol Oncol 1993; 49: Feeney DD, Moore DH, Look KY, et al. The fate of the ovaries after radical hysterectomy and ovarian transposition. Gynecol Oncol 1995; 56: Crook JM, Esche Ba, Chaplain G, et al. Dose-volume analysis and the prevention of radiation sequelae in cervical cancer. Radiother Oncol 1987; 8: Eifel PJ, Levenback C, Wharton JT, et al. Time course and incidence of late complication in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1995; 32: Bye A, Trope C, Loge JH, Hjermstad M, Kaasa S. Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy--evaluation of long-term effects of diagnosis and treatment. Acta Oncologica 2000; 39: Grigsby PW, Russell A, Bruner D, et al. Late injury of cancer therapy on the female reproductive tract. Int J Radiat Oncol Biol Phys 1995; 31: Christman NJ, Oakley MG, Cronin SN. Developing and using preparatory information for women undergoing radiation therapy for cervical or uterine cancer. Oncol Nursing Forum 2001; 28: 93-98

7 37. Morita K. Cancer of the cervix. In: Vahrson HW, editor. Radiation oncology of gynecological cancers. First edition. Berlin: Springer-Verlag; 1997:

8 28 Long-term Quality of Life for Patients with Early Stage Uterine Cervical Carcinoma after Treatment WEI-CHUNG HSU 1 NA-NA CHUNG 2 YU-CHIA CHEN 3 SUE-CHING CHAN 4 LAI-LEI TING 2 CHUNG-HUANG TSAI 5 HSUEH-FENG WANG 6 PO-MING WANG 1 GAU-DE LIN 7 Department of Radiation Oncology 1, Family Medicine 5, Nursing 6, General Surgery 7, Cheng-Ching General Hospital Division of Radiation Oncology, Department of Oncology 2, National Taiwan University Hospital Department of Social Work 3, National Pingtung University of Science and Technology Department of Pharmacy 4, Buddhist Tzu-Chi General Hospital To compare the difference between treatment modalities for long-term quality of life (QoL) in patients with early stage uterine cervical carcinoma. From March 2002 to April 2003, two hundred and seventeen patients of two institutions were invited to participate. Inclusive patients were followed for at least 2 years after the completion of the treatment. They were divided into 2 groups by different treatment modalities: surgery with postoperative radiation therapy (OP+RT) and radiation therapy alone (RT alone). QoL were assessed by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ C-30) and side effects for uterine cervical cancer after treatment. Relative high side effects in early stage uterine cervical cancer patient treated by OP+RT were: constipation (46.8%, p < 0.001), edema of lower extremities (24.3%, p = 0.004), urine incontinence (40.5%, p = 0.041) and hot flush (13.5%, p = 0.050). Relative high side effects in early stage uterine cervical cancer patient treated by RT alone were: diarrhea (45.3%, p = 0.008) and increased vaginal discharge (14.2%, p = 0.029). The EORTC QLQ C-30 QoL items were significant better in OP+RT groups as comparison with RT alone group, including global health status (p = 0.043), cognitive function (p = 0.033), social function (p = 0.037), nauseavomiting (p = 0.027), pain (p = 0.031), poor appetite (p = 0.009) and financial problem (p = 0.009). Constipation was worse significantly in OP+RT group than in RT alone group (p = 0.002). Our study provided comparison and analysis of long-term QoL and side effects in early stage uterine cervical cancer patients treated by different modalities. These data were helpful for clinical physician not only for selecting treatment modalities when concerning with QoL of the patients, but also for rehabilitation and supportive care of the patients after treatment. Key words: EORTC; Quality of life; Radiotherapy; Uterine cervical cancer